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    Friday, May 28, 2004

    The Truth is Out There: The daily ablution analyzes the politics of obesity as explained by Polly Toynbee. (via Jane Galt.
     

    posted by Sydney on 5/28/2004 12:38:00 PM 0 comments

    Health Blog Expansion: Health Signals is a healthcare policy blog that looks at the politics and financing of healthcare, including this interesting post on what happens when Medicaid is too generous.
     
    posted by Sydney on 5/28/2004 12:27:00 PM 0 comments

    Stem Cell Wars: The down and dirty politics behind stem cell research.
     
    posted by Sydney on 5/28/2004 08:49:00 AM 0 comments

    Radiowave Surgery: A little girl in England had her tonsillectomy broadcast on the internet: "

    A pioneering operation to remove a young girl's tonsils - live on the internet - has been hailed a success.

    Consultant surgeon Michael Timms operated on Jessica MacNeal, seven, from Blackburn, Lancashire, at the town's Royal Infirmary.

    He used a new procedure - coblation tonsillectomy - which is said to be faster and less painful than the conventional surgery.

    It uses salt water which is turned into a plasma that can cut through tissue.


    That's not quite correct. The procedure was radiofrequency ablation, which uses radiofrequency energy to destroy tissue in a controlled fashion. Cardiologists routinely use it to modify electrical pathways in the heart. It's also used in prostate surgery. I suppose this is an attempt by the company to to convince the NHS to cover it for the much more routinely done tonsillectomy.

    How did the surgery go?

    Jessica's mother, Sharon, said: "I feel happy for Jessica. She is wide awake, drinking and smiling. It is brilliant.

    "Nobody should be concerned about this operation."

    "I had my tonsils out 20 year ago and it is amazing how they do it nowadays," said her father William, also 31.


    That's nothing. In the 1930's my father-in-law had his tonsils removed on the kitchen table. Can't get more convenient than that.
     
    posted by Sydney on 5/28/2004 08:39:00 AM 0 comments

    Shocking Appetites: A stomach pacemaker for appetite control.
     
    posted by Sydney on 5/28/2004 08:37:00 AM 0 comments

    Adjustment Disorder: All this talk about Al Gore's MoveOn speech, has me wishing he would move on. A man who was once a voice of moderation has gone raving. It's understandable after so narrow and contentious a loss of a life-long dream that he would be disappointed and bitter. But disappointments, no matter how great, don't have to ruin a life. They can also be springboards to a better self. That is, if they're not allowed to become all-consuming.

    It's been nearly four years since Al Gore's devastating experience. It's time he pulled himself together. Or risk becoming this.
     
    posted by Sydney on 5/28/2004 08:36:00 AM 0 comments

    Low Carb Fads: A reader had this to say about low-carb foods, some of which she's tried:

    I've also seen reduced-sugar Frosted Flakes and Froot Loops in the store.

    Actually, this could be a benefit of low-carb-mania: maybe some of the food producers will cut back on some of the (excessive, to my taste) sugar in food and replace it with...nothing. (Maybe I'm just a "supertaster" but most sweetened things seem excessively sweet to me, to the point where all I taste is sweet, and nothing else.).

    I tried the reduced-sugar Froot Loops (yeah, I know, it's still like eating candy but I loved Froot Loops as a kid and I was curious). They didn't taste noticeably "unsweet" to me, if anything, they were not noticeably different from the full-on-sugar kind. (I think Kellogg's could cut the sugar by 1/2 rather than the 1/3 they said they did and the cereals would be just fine. Maybe they could even cut it by 2/3).

    I've thought for years that food processors were adding too much sugar and salt to foods, maybe now with people trying to reduce carbohydrates in their diets we'll get more foods that taste like food instead of sugar or salt. (Although I guess Atkins doesn't say a whole lot about cutting back on salt...)


    Got a point there.
     
    posted by Sydney on 5/28/2004 08:20:00 AM 0 comments

    Low Carb Fads: Michael Fumento argues that journalists are too credulous when it comes to the Atkins diet. Meanwhile, a former Atkins dieter is suing the Atkins estate for his heart disease:

    Jody Gorran, 53, says that after two years on the Atkins diet his arteries became so clogged he needed surgery.

    Mr Gorran went on the Atkins diet, which recommends a low carbohydrate, high protein regime, when his weight rose by 8lbs. After two months his cholesterol levels rocketed from 148, which is normal, to 230, which is harmful.

    After three bouts of chest pain his doctors discovered that he had a 99% blockage in a major artery and had to perform an angioplasty and insert a stent - a small wire mesh tube - to keep it open.

    'I came very close to dying and this is from a diet I thought was marvellous,' said Mr Gorran yesterday. 'For two-and-a-half years, I extolled the virtues of this diet to anyone who listened because I was losing weight and I felt great. But when I started, I had no idea I was making a deal with the devil for trying to keep a 32-inch waistline.'


    Oh please. His cholesterol level may have gone up on the diet, but the idea that it clogged his arteries in a short time, like rice stuck in a drain pipe, is ridiculous. Cholesterol works its damage over years. And it's only one of many risk factors for heart disease. The story doesn't say if Mr. Goran lost weight on the diet, or if he smokes or has a family history of heart disease. But the chances that his diet caused his narrowed arteries are slim to none.
     
    posted by Sydney on 5/28/2004 08:11:00 AM 0 comments

    Thursday, May 27, 2004

    Kitchen Care: Advice on eyes and chili peppers. (via Dr. Alice.
     

    posted by Sydney on 5/27/2004 05:06:00 PM 0 comments

    MedMal Crisis Update: Bard-Parker has a synopsis of how things are going in West Virginia. Their work stoppage was effective.
     
    posted by Sydney on 5/27/2004 04:59:00 PM 0 comments

    Creepy Crawlies: A case study from the New England Journal of Medicine:

    A 24-year-old man and his fiancée had pruritus of two months' duration. They had similar skin lesions, with burrows on the webs between their fingers. A specimen obtained from scrapings of the woman's hand was prepared and examined with the use of a scanning electron microscope.

    Most of us have to make due with a humble light microscope. We don't get to see impressive bugs like this. Here and
    here are examples of the typical scabies rash. And here's what the typical doctor sees when he finds the little creatures in a skin scraping.
     
    posted by Sydney on 5/27/2004 10:28:00 AM 0 comments

    This Imperfect World: That all too fallible prostate cancer screening test, the PSA, is back in the news. The most recent study says that it's missing too many cancers:

    A study out Thursday confirms that prostate cancer may be present even among patients with so-called "normal" scores on the PSA, or prostate-specific antigen test. Researchers say the findings show that a better screening test is needed.

    ....Doctors who studied nearly 3,000 men found cancers in 15% of those with PSA levels below 4, shows research in Thursday's New England Journal of Medicine. The risk of prostate cancer rose with increasing PSA levels.

    .....Some experts say such findings illustrate the need for more aggressive screening and treatment. The National Comprehensive Cancer Network, a group of 19 leading hospitals, recommended earlier this year that doctors should consider biopsies for men with PSA scores above 2.5.


    But wait, there's more to it. For one thing, most of the cancers were not life threatening:

    When examined under a microscope, however, relatively few of these cancers were found to be dangerous.

    The study's authors noted that the PSA test gives doctors few clues about which cancers will ever threaten a man's life. High scores can be caused by many conditions, from cancer to infections or a benign swelling of the prostate gland that is common in older men.

    ...."There is no magic cutoff below which a man can assume he is completely free of risk or above which he must feel compelled to have a biopsy," said Howard L. Parnes, an author of the study and chief of the prostate and urologic cancer research group at NCI. "We need to get back to basics and allow each man, with the help of his physician, to assess his own risk."


    Exactly. We live in an imperfect world, and unfortunately, prostate cancer is one of the cancers for which we have no good screening test yet. Beware of organizations made up of hospitals and urologists who call for lower thresholds for treatment. They have much to gain from the increased number of biopsies such lower thresholds would produce. Unfortunately, it's far from clear that patients would benefit as well.

    ADDENDUM: Here's the data from the study:

    Among the 2950 men (age range, 62 to 91 years), prostate cancer was diagnosed in 449 (15.2 percent); 67 of these 449 cancers (14.9 percent) [or 2% of the subject population -ed.] had a Gleason score of 7 or higher. The prevalence of prostate cancer was 6.6 percent among men with a PSA level of up to 0.5 ng per milliliter, 10.1 percent among those with values of 0.6 to 1.0 ng per milliliter, 17.0 percent among those with values of 1.1 to 2.0 ng per milliliter, 23.9 percent among those with values of 2.1 to 3.0 ng per milliliter, and 26.9 percent among those with values of 3.1 to 4.0 ng per milliliter. The prevalence of high-grade cancers increased from 12.5 percent of cancers associated with a PSA level of 0.5 ng per milliliter or less to 25.0 percent of cancers associated with a PSA level of 3.1 to 4.0 ng per milliliter.

    And here's what the authors of the study have to say about PSA thresholds:

    A decision to lower the current PSA threshold for biopsy, however, should be considered within the broader context of the PSA-screening debate. Although the use of PSA testing in the United States has led to earlier diagnosis and a marked shift in the stage at which prostate cancer is identified, it is unclear whether PSA testing reduces the rate of death from prostate cancer.....Although clinically important cancers are not always fatal, the large difference between a man's risk of death from prostate cancer (3 to 4 percent) and his lifetime risk of the diagnosis of prostate cancer (16.7 percent) suggests that many prostate cancers detected in routine practice may be clinically unimportant. Lowering the PSA threshold for proceeding to prostate biopsy would increase the risks of overdiagnosing and overtreating clinically unimportant disease.
     
    posted by Sydney on 5/27/2004 10:06:00 AM 0 comments

    Wednesday, May 26, 2004

    Losing Proposition: One doctor's experience with the litigation system. She describes it as something akin to character assassination. Which it is, if you think about it. The purpose of our court system (at least in the tort arena) is to provide a neutral arena in which air and solve disagreements. But with liability cases, it not only ends up being used as a weapon, but also causing damage to reputations. How many doctors out there are paying higher malpractice insurance premiums because they've been unjustly sued - even once. Even when there was no real harm done, but only a complication from a procedure that's known to happen in a certain percentage of cases (as in this case)? This doctor isn't being unusually sensitive. The repurcussions of a malpractice suit go on and on - even if the doctor wins.

    (via Overlawyered.)
     

    posted by Sydney on 5/26/2004 12:57:00 PM 0 comments

    The Lame Shall Walk: Researchers have made paralyzed rats walk again. And they did it not with stem cells, but with adult rat nerve cells:

    Researchers first inject the rats with Rolipram, a drug that stops the loss of a growth-enhancing chemical called cyclic AMP, which occurs just after a spinal cord injury. Researchers then take cells from the rats' peripheral nerves, grow those in the lab and transplant them into the injured area, followed by one-time injections of cyclic AMP above and below the transplant site. The injections raise the levels of cyclic AMP, enhancing the environment for the growth of nerve fibers, Bunge says.

    Naomi Kleitman of the National Institute of Neurological Disorders and Stroke says the strategy is a "significant advance over what has been reported before" and is "likely to be applicable clinically if the progress continues."

    The animals went from being able to take only occasional steps to walking in a coordinated way, with hind and fore paws working together...


    Fascinating.
     
    posted by Sydney on 5/26/2004 08:43:00 AM 0 comments

    Low Carb Craze: Coca-Cola hops on the band wagon. They call it a "mid-calorie" Coke.
     
    posted by Sydney on 5/26/2004 08:36:00 AM 0 comments

    An Aspirin a Day Keeps the Doctor Away: News reports say that aspirin may prevent breast cancer:

    A study involving 2,884 women found that those who took aspirin on a regular basis were about 28 percent less likely to develop breast cancer than those who never used the popular painkiller.

    The findings are the latest in a series of studies that have indicated aspirin may do far more than relieve headaches, backaches and fevers. In addition to reducing the risk for heart attacks, several studies indicate it may cut the risk for various cancers, including breast cancer.


    Emphasis on the word "may." As in if you take an aspirin a day and your twin sister doesn't, don't be surprised if you get breast cancer while she remains cancer free. The study was a retrospective one, meaning the researchers gathered women who had already been diagnosed with cancer then gathered other women who did not have cancer but who matched the cancer group demographically. Then, because they were interested in whether or not anti-inflammatories might have a role in preventing cancer, they asked each group about their use of such anit-inflammatories as aspirin and ibuprofen (Motrin). (They also asked about Tylenol use, but Tylenol isn't an anti-inflammatory. Interestingly, there was no difference in Tylenol use between the two groups.) What they found was that more women, by a very small margin, who did not have breast cancer used aspirin regularly or semi-regularly than women who had breast cancer.

    The data show that the difference in aspirin use between the two groups was only three percentage points. Of women who had breast cancer, 21% had taken aspirin at least once a week for six months or longer. Of women without breast cancer, 25% had taken aspirin once a week for six months or longer.

    Even if broken down into frequency and duration of aspirin use, the numbers are still underwhelming. Aspirin use varies only by two to three percentage points at the most. Among healthy women 7.5% took aspirin daily for five years or more, compared to 6.5% of women with breast cancer.

    The numbers don't prove that aspirin prevents breast cancer. They only show an association (and a tenuous one at that) between aspirin use and the breast cancer-free state.

    Now, this is certainly a finding that researchers would find stimulating. Their job is to look for trends that can turn their minds toward new avenues of exploration. A biochemist may look at this data and decide to explore the relationship between the chemistry of inflammation and the genesis of breast cancer. But when it comes to day to day medical therapy, it falls far short of proving aspirin as a preventative for breast cancer.
     
    posted by Sydney on 5/26/2004 08:23:00 AM 0 comments

    State of Unpreparedness: This is worrisome:

    A Russian scientist at a former Soviet biological weapons laboratory in Siberia has died after accidentally sticking herself with a needle laced with ebola, the deadly virus for which there is no vaccine or treatment, the lab's parent Russian center announced over the weekend.

    Scientists and officials said the accident had raised concerns about safety and secrecy at the State Research Center of Virology and Biotechnology, known as Vector, which in Soviet times specialized in turning deadly viruses into biological weapons. Vector has been a leading recipient of aid in an American program to help former Soviet scientists and labs convert to peaceful research.


    The lab didn't report the incident until two weeks afterwards, and they haven't been very forthcoming about the research the scientist was doing or who was funding it. Makes you wonder what they're up to. And this makes it even more worrisome:

    Vector is also one of two repositories of the deadly smallpox virus - the other is the Centers for Disease Control and Prevention in Atlanta. Since the Soviet Union collapsed, the United States has spent millions of dollars to help convert such places to peaceful research, including an estimated $10 million at Vector.

    Critics of the program have opposed expanding such aid because it is hard to verify whether former Soviet scientists are using the American-supported research for peaceful purposes. But the program's defenders say it keeps scientists employed on peaceful projects and prevents them from working for anti-American states or terrorists seeking biological weapons.


    Maybe the heightened terror alert just has me in a state of paranoia, but the fact that the Russians have been making new friends isn't very reassuring, either.
     
    posted by Sydney on 5/26/2004 07:46:00 AM 0 comments

    Tuesday, May 25, 2004

    Have a Cuppa: "You've never been so awake." (Thanks to a reader who sent along the link.)
     

    posted by Sydney on 5/25/2004 08:32:00 AM 0 comments

    Hiccups: How long can a person hiccup? A very long time:

    John Francis Crosland has been hiccuping for more than 40 years. Every day since John F. Kennedy was first in office as president, Crosland has gulped or gasped or had that catch in his throat.

    “I just hiccup all the time. A lot of times I be doing something and hiccuping, and I don’t pay them no attention,” he said. “If you want to know the truth, it don’t too much matter. It worries other people more than it worries me.”

    ....The Guinness Book of World Records lists an Iowa man, Charles Osborne, as having them the longest: 69 years. Osborne was slaughtering a hog in 1922 when he first began hiccuping, and he is said to have hiccuped at the rate of 40 times a minute until February 1990.


    Why do some of these tics of the diaphragm last so long? A lot of times we don't know:

    Doctors, he said, never told him what caused the hiccups. Doctors, he said, never told him why they settle quietly in his throat when he’s calm and relaxed. But he has a hunch: He attributes them to a car accident.

    “As far as I can remember, I weren’t sick or nothing,” he said. “When I were 15 years old, I was in a car wreck. The car turned over. It threw both of us out.”

    A friend had borrowed an uncle’s brand new Ford automobile, and Crosland went along for the ride out in the country. They were running too fast when the car turned a curve, and both young men were thrown out, into a field. Neither was hurt too bad.

    But Crosland said the jugular vein on the right side of his neck swelled up “twice the size of an egg.” Even now, when he gets to hiccuping, he can massage the vein and it slows them down.

    Once he gets tired, excited, upset or whenever he gets to talking too fast, the hiccups come faster. It can reach a point where, with all the gurgling, he sounds more like he’s stuttering. Sometimes it’s like he loses his breath, like he’s got asthma.


    He's probably right about the accident being the cause. Head trauma can cause intractable hiccups. So can damage to the phrenic nerve or vagus nerve, both of which run through the neck in close proximity to the jugular vein.

    Whether they're intractable or short-lived, they're difficult to treat, but they have an interesting etymology. The commonly used "hiccup" is onomatopoeic, in English and in French. But the medical term, "singultus" is from the Latin for "convulsive sob," which is also how it was described in classical Greek, Italian, Russian, Portuguese, Spanish, and even Old English (before they were influenced by the French.)
     
    posted by Sydney on 5/25/2004 08:28:00 AM 0 comments

    Redefining Normal: How do you get an insurance company to pay for a drug so that more people will take it? Do a study that shows even asymptomatic people benefit from it, as in this osteoporosis study:

    A study suggests some women might benefit from taking bone-boosting drugs earlier than many doctors recommend, because they can break bones well before they develop full-fledged osteoporosis.

    The study involved 149,524 white postmenopausal women, age 65 on average, who had bone density scans. Of the 2,259 who broke bones during the following year, 82 percent had initial bone-density scores indicating thinning bones but not osteoporosis.

    Only 18 percent of women with fractures had scores at or above the threshold many doctors use to define osteoporosis and to prescribe drugs.

    The study was led by Dr. Ethel Siris at Columbia-Presbyterian Medical Center and included researchers from Merck & Co., which makes the osteoporosis drug Fosamax and funded the study. A Merck doctor participated in a committee that oversaw the study design and analysis, Siris said.


    I hate to burst their bubble, but even people with healthy bones can break them. All you have to do is fall with enough force or awkwardness. A fracture is not necessarily a sign of bad bones.

    The study's abstract says that there were 57,421 postmenopausal women with normal bone densities and out of those 1130 had fractures during the year of the study. That's only 2%. (Not sure why there's such a marked difference between the news story's numbers and the abstract's, unless there's some sort of information in the subscription only body of the text that disqualifies a lot of the subjects and increases the number of those who sustained fractures. Hard to understand how that could be, though.)

    The abstract doesn't make clear what kind of fractures these were, whether they were from accidents and pratfalls, or if they were the sort of spontaneous, surprise fractures that happen in osteoporosis. It's not inconceivable that two percent of women over 65 fall at some point over a year's time. Are these researchers really suggesting that taking osteoporosis drugs will prevent all, or even most, fractures in healthy bones? If so, we'd better start giving them to those tree-climbing, swing-jumping monkeys we call children.

     
    posted by Sydney on 5/25/2004 07:59:00 AM 0 comments

    Ties that Bind: I've always admired, and been a little envious of, the expressive neckties that male physicians get to wear. Ties like this, this, and even this. There just is no analogous piece of women's clothing that can be this playful. Those ties have their disadvantages, though. They are bacteria-mongers.
     
    posted by Sydney on 5/25/2004 07:58:00 AM 0 comments

    Cosmetic Fallacy: This month's Medical Letter has an item about cosmetic phalloplasty and its hazards. It appears to be a popular procedure. Do a Google search on it and no shortage of plastic surgeons pop up offering to do the same through surgery that all those spam emails offer through herbs and supplements. Phalloplasty has traditionally been used for those who suffer trauma or birth defects that leave the penis deformed. But evidently there's a booming business in the surgery for cosmetic sake only. Basically what they do is cut the ligaments holding the organ to the body, add some fat, redistribute a little skin, and presto there's the appearance at least of a larger endowment.

    According to the Medical Letter the results are "generally disappointing," with complications that can be disfiguring - scarring, unsightly lumps, numbness, and erectile dysfunction. Just remember that if you're considering such a drastic move. Function over form.
     
    posted by Sydney on 5/25/2004 07:37:00 AM 0 comments

    Monday, May 24, 2004

    Breasts, Cancer, and Art: An oncological look at the left breast of Michelangelo's Night.
     

    posted by Sydney on 5/24/2004 08:33:00 AM 0 comments

    Breasts, Cancer and Sex: Male breast cancer is a rare disease, but still one to keep in mind when a lump appears. A new study from the M.D. Anderson Cancer Center says it's incidence is increasing, although slightly:

    .....a comprehensive study of more than 2,500 male breast cancer patients diagnosed with the disease between 1973 and 1998 to better determine its prevalence, survival rate and differences between men and women.

    What she found surprised her. The incidence of breast cancer in men rose 25 percent over the years of the study, from 0.86 cases per 100,000 men to 1.08 cases.

    ....Overall survival rates for the disease are 63 percent after 5 years, and 41 percent after 10 years.


    The study is to be made available online here, but doesn't appear to be up yet. It's hard to say from the news reports whether or not the slight increase in incidence may be due to increased longevity. (Cancer is one of those diseases you are more apt to get the longer you live.)

    The same researcher published a review of male breast cancer two years ago in the Annals of Internal Medicine, a synopsis of which is here. The risk factors and presenting symptoms:

    "....up to 20 percent of male breast cancer cases have been associated with Klinefelter's syndrome. A family history of breast cancer, especially in first-degree relatives, is an important predisposing factor. Men with mutations of the breast cancer susceptibility gene BRCA2 have a higher risk of breast cancer. Gynecomastia is not a risk factor for breast cancer in men.

    The most common clinical presentation is a painless subareolar mass. Other common presenting signs include nipple retraction, local pain, nipple ulceration, bleeding, and discharge.

    This concludes our public service announcement.
     
    posted by Sydney on 5/24/2004 08:30:00 AM 0 comments

    New Healthcare Blog: CodeBlueBlog by a (I think) retired radiologist. Lots of thoughts about the economics of healthcare, including these trenchant observations about Hillary Clinton and medicine:

    She's a lead battery in a Nickel Cadmium world. Hillary doesn't quite understand the health care system and has no real life experience in the field to compensate. She's an empty policy vessel rattling in the vacant room of her arrogance.

    Scathing but, one senses, also true.
     
    posted by Sydney on 5/24/2004 07:46:00 AM 0 comments

    Presidential and Near-Presidential Health: President Bush wrecked his bike this weekend:

    President Bush suffered cuts and bruises early Saturday afternoon when he fell while mountain biking on his ranch, White House spokesman Trent Duffy said.

    Bush was on the 16th mile of a 17-mile ride when he fell, Duffy said.


    He wasn't just tooling around, but mountain biking, as if he's twenty-something instead of fifty-something. Sixty-year-old Senator John Kerry suffers from the same urge to prove himself, which has resulted in falls while snowboarding and bicycling.

    There's a long history of leaders anxious to prove their physical strength, from Henry VIII challenging the King of France to a wrestling match to Franklin Roosevelt standing for hours on train platforms despite his polio-weakened legs. But things are getting out of hand. Just about every president for the past thirty years has gone out of his way to prove his vim and vigor, as if the office required a strong body rather than a strong heart and mind. Reagan chopped wood, George H.W. Bush, though more partial to power-boating and golf, sometimes tossed baseballs, and many others have made jogging a required ritual for office.

    It's enough to make you long for the days of President Taft, whose only exercise consisted of looking for the next snack.
     
    posted by Sydney on 5/24/2004 07:22:00 AM 0 comments

    Sunday, May 23, 2004

    Statins! Statins! Get Your Statins! As those of you who read medical weblogs regularly know by now, the British government announced a couple of weeks ago that they would allow statins, the cholesterol lowering drugs, to be sold over the counter. The drug in question is Zocor, at a 10 mg dose. Pharmacists in the UK will have to screen the customers by asking them a series of questions, since it will be only approved for those at risk for heart disease and strokes. Well, the medical establishment has now had time to chew that development over and make their replies:

    While pharmacists' groups and the British Heart Foundation backed the reclassification, others have not been so supportive. Dr John Chisholm, chairman of the BMA's General Practitioner Committee, was concerned that patients would not have a thorough risk assessment, that the dose may be too low, and that there was potential for side effects.

    'If a drug treatment is worth taking it should be provided equitably and available to all patients at NHS expense and on the basis of need, not their ability to pay,' he said. The King's Fund, a charitable health research foundation, said it was another example of 'creeping charges' in the NHS.

    The Consumers' Association said no specific clinical trials had proved that selling the product over the counter was effective in the target population. It also said that the real reason behind the switch was that simvastatin lost its patent protection in May 2003.


    As DB over at Med Rants put it, it really is about the money. The British government has to spend billions on statin therapy through the NHS. By making them over-the-counter, they put the cost burden on the patient. And both the pharmacists and the drug company stand to make more money by putting them on the unrestricted open market.

    But is this a medically wise move? The evidence would suggest not. Here's a look at the studies on statins in primary prevention for heart attacks and strokes:

    In the pooled data the statins reduced the cardiovascular measures, total myocardial infarction and total stroke, by 1.4% as compared to control. This value indicates that 71 mostly primary prevention patients would have to be treated for 3 to 5 years to prevent one such event.

    Even more worrisome, none of the studies took a good look at adverse events from using statins. And although there's a slight decrease in heart attacks and strokes, the overall mortality is the same whether or not patients took statins. You might be decreasing your risk of a quick death by heart attack, only to have it be substituted by a slow death from cancer. Or emphysema. Or some other chronic illness.

    Compare that to aspirin, which we currently recommend for the prevention of strokes and heart attacks:

    For patients similar to those enrolled in the trials, aspirin reduces the risk for the combined endpoint of nonfatal myocardial infarction and fatal coronary heart disease (CHD) by 28 percent .....For 1,000 patients with a 5 percent risk of CHD events over 5 years, aspirin would prevent 14 myocardial infarctions.

    That translates into 71 people taking aspirin to prevent one heart attack, a slight advantage over statins. But where the difference really comes in is in the price tag. A one month supply of ten milligrams of Zocor costs $69.99 at Drugstore.com, but five months of aspirin is only $7.29.

    Now, the statin proponents will argue that aspirin is more dangerous than statins. It can cause bleeding in the brain (hemorrhagic stroke) and in the gut (bleeding ulcers.) And in fact, the data on aspirin show that out of 1000 people taking it for five years, one would have a hemorrhagic stroke and three would have a gastrointestinal bleed. We know the risks of aspirin. It's a drug that's been widely used for over a hundred years. We don't know all the risks of statins. They've only been widely used for around fifteen years. And the fact that the studies used to support their widespread, barely discriminate use ignore adverse effects is not reassuring. It's even more disturbing to hear their proponents claiming they have no adverse effects, because they do. It's just plain hubris to suggest otherwise.

    ADDENDUM: If all that talk about aspirin side effects gives you the willies, you can go here to calculate your risk of heart disease over the next ten years. If it's less than five percent, you probably don't need to take aspirin.
     

    posted by Sydney on 5/23/2004 03:19:00 PM 0 comments

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