Heart Treatments for Diabetes Causing Harm
March 16, 2010
The New York Times
By Gina Kolata
Three aggressive treatment strategies doctors had expected would prevent heart attacks among people with Type 2 diabetes and some who are the verge of developing it have proved to be ineffective or even harmful, new studies show.
The results are surprising and disappointing, heart and diabetes experts say. An estimated 21 million Americans have Type 2 diabetes, the kind once known as adult-onset, and they are at enormous risk for heart disease. The only measures proved to reduce their chances — avoiding cigarettes and taking medication to lower bad cholesterol and blood pressure — still leave diabetics with a heart attack risk equivalent to that of a nondiabetic who has already had a heart attack.
So doctors began trying other strategies they hoped would help: getting blood pressure to a normal range; raising levels of good cholesterol and lowering levels of dangerous triglycerides; or modulating sharp upswings in blood sugar after a meal.
It is not known how many doctors have been encouraging patients to take these measures, but medical specialists say it seemed reasonable and tempting to do so.
“Doctors always want to improve the lives of their patients, and that often leads to pressure to treat more and more,” said Dr. Henry N. Ginsberg, director of the Irving Institute for Clinical and Translational Research at Columbia University. The new studies, he says, could save a lot of people from taking drugs that will not help them.
The papers were presented at an American College of Cardiology meeting on Sunday and are being published online by The New England Journal of Medicine.
In Type 2 diabetes, the body is resistant to the hormone insulin, leading to abnormally high blood sugar levels that can cause eye, kidney and nerve disease. But heart disease is what kills most patients. A quarter to a third of heart attack patients have diabetes, even though diabetics constitute just 9 percent of the population. And 25 percent of heart attack patients are on the verge of diabetes, with abnormally high blood sugar levels.
High blood sugar levels themselves increase the risk of heart disease, but researchers found two years ago that rigorously controlling blood sugar did not prevent heart disease or deaths in people with Type 2 diabetes. Researchers said the failure was probably because most of those patients also had other problems that made their odds of heart disease soar, like high levels of LDL cholesterol, low levels of HDL cholesterol, high levels of triglycerides and high blood pressure. And most were older and overweight.
Type 2 diabetes “captures all these risk factors in one patient,” said Dr. David Nathan, director of the diabetes center at Massachusetts General Hospital.
It seemed logical to look at the other risk factors. One large federal study asked if getting high blood pressure down to a level considered normal, a systolic pressure of no more than 120, would help protect diabetics from heart disease and save lives.
This hypothesis was promising because studies that observed populations found that heart disease and stroke risk increase continuously as systolic blood pressure rises from 115 on up, said Dr. William C. Cushman, a study investigator and chief of the preventive medicine section at the Veterans Affairs Medical Center in Memphis.
To put the idea of a normal blood pressure to the test, half of the study’s 4,773 participants took drugs to get their systolic blood pressure to 120 or below. The rest had a blood pressure goal of less than 140.
But lower blood pressure did not prevent heart attacks or cardiovascular deaths, and those with lower blood pressure were more likely to suffer severe side effects from the drugs, like high potassium levels or dangerously low blood pressures. They also took an average of 3.4 drugs to lower blood pressure, compared with an average of 2 drugs for those with the higher pressure.
A second, less rigorous study, involving 6,400 patients with Type 2 diabetes and heart disease, asked whether getting systolic blood pressure lower than 130 was any better than getting it to 130 to 140. It found that patients actually were worse off: those with the lower blood pressure ended up with a 50 percent greater risk of strokes, heart attacks or deaths.
National blood pressure treatment guidelines call for a systolic pressure of 130 or lower. That was based on expert opinion and observational studies, Dr. Cushman said. Now, he said, it is likely to be reconsidered when the group that sets the guidelines prepares a report this year.
People with diabetes also tend to have low levels of HDL cholesterol and high levels of triglycerides, a combination known to increase the risk of heart disease. And in some studies, treating that combination with a type of drug called a fibrate reduced risk in diabetics and nondiabetics who were not taking statins. So it made sense to see if fibrates also helped Type 2 diabetics who were taking statins.
It did not, concluded another arm of the federal study involving 5,518 people with Type 2 diabetes.
“It’s a disappointment,” said Dr. Ginsberg, a lead study investigator. “But it’s very, very important,” because it says most people will not be helped by taking the additional drug.
It means, said Dr. Denise Simons-Morton of the National Heart, Lung and Blood Institute, the project officer for the federal study, that “doctors and patients now know that the inclination to do intensive treatment that people seemed to think would be better for cardiovascular risk reduction wasn’t better.”
A final studyinvestigated the popular hypothesis that rapid rises in blood glucose after a meal were dangerous and could lead to heart disease. Many doctors were giving drugs assuming the hypothesis was correct, Dr. Nathan said.
“Every meeting you go to, some academic is talking about how postprandial hyperglycemia is really bad and that you should aim specifically to get it lower,” Dr. Nathan said. The study, he said, “is a direct test of that.”
The study, which involved 9,300 patients at high risk for diabetes because their blood sugar was high, tested the drug nateglinide, which enhances insulin secretion. It also tested a blood pressure drug. Neither decreased heart disease risk.
“Neither drug should be used in people with impaired glucose tolerance but not diabetes in order to prevent cardiovascular events unless there is another indication, like significant hypertension,” said Dr. Robert M. Califf, vice chancellor for clinical research at Duke University School of Medicine and chairman of the study.
Dr. Nathan, who wrote an accompanying editorial in The New England Journal of Medicine, agreed. “It is a negative study,” he said.
Some, like Dr. Daniel Einhorn, president-elect of the American Association of Clinical Endocrinologists, say the results of that study and the others would not necessarily dissuade him from taking such intensive measures with individual patients.
“It’s hard to make a case for a public health recommendation,” Dr. Einhorn said. “But that doesn’t mean there isn’t a benefit in an individual case.”
But no benefit has been shown, Dr. Nathan noted. The lesson, he said, is that while making logical leaps to aggressively treat patients with Type 2 diabetes was “totally understandable,” it was also dangerous.
“Lower is not necessarily better,” Dr. Nathan said.
Click here for the full report.
Doctors Calling for Trans Fat Ban
March 16, 2010
Natural News
By E. Huff
The Faculty of Public Health (FPH) in the U.K. is urging British lawmakers to ban trans-fats from the British food supply because the artificial fats are causing heart attacks, strokes, and other serious diseases. Comprised of 3,300 doctors and health specialists, FPH hopes to follow in the footsteps of places like Denmark, Austria, and Switzerland which have all banned trans-fats from their food supplies.
Trans-fats are derived from vegetable oils that have been chemically modified. They bear no nutritional value but are used by food manufacturers to bulk up foods and extend their shelf life. Typically labeled as hydrogenated or partially hydrogenated, these artificial fats are commonly found in processed baked goods and desserts, pastries, and fast foods as well as in margarine and shortening.
Experts recognize that trans-fats increase levels of “bad” LDL cholesterol which can lead to serious health problems like heart disease, diabetes and stroke. Because heart disease rates are already very high in the U.K., FPH and others hope to see trans-fats eradicated in order to improve overall public health.
The Royal Society for Public Health, the Royal College of General Practitioners, and the National Health Forum all agree with FPH about the dangers of trans-fats and are urging their removal. Since data shows that over 250,000 Britons suffer from a heart attack or stroke every year and almost 140,000 of them die as a result, these groups believe it is crucial that government officials reevaluate their position on trans-fats.
Alan Johnson, former British health secretary, requested back in 2007 that the Food Standards Agency perform an investigation into trans-fats. When the agency declared that all was well and that people were consuming on average far less than the government-established maximums for trans-fats, no action was taken. Citing this previous find, the Department of Health continues to oppose banning trans-fats.
Many British food producers are voluntarily removing trans-fats from their products to meet consumer demand, including all the members of the British Retail Consortium who pledged in 2006 to remove trans-fats from their products. These reduction efforts and others have led to an overall drop in trans-fat consumption to one percent of the total energy being derived from foods.
As it stands, there is no law mandating that manufacturers even have to list trans-fats on their ingredient labels, a transparency failure that many hope will be addressed by government officials. At the very least, people should know whether or not the foods they buy contain trans-fats so they can make informed purchasing decisions.
Click here for the full report.
Breaking Down Cholesterol
March 16, 2010
Natural News
By Dr. Julian Whitaker
I’d like to shine the spotlight on one of medicine’s sacred cows- the belief that lowering cholesterol with drugs protects against heart attacks and premature death. Our obsession with cholesterol began in the 1950s when studies linked high consumption of animal fat with high rates of heart disease. This opened the door for clinical trials that laid the foundation of a new paradigm: the cholesterol theory of cardiovascular disease.
This theory has had profound ramifications. It changed the way we eat (fats bad, carbohydrates good) and contributed to our problems with obesity and diabetes. It wormed its way into “clinical practice guidelines”- cholesterol management has become a “standard of care” that doctors are expected to follow. It spawned the invasive heart surgery industry, based on the presumption that cholesterol-laden blockages must be bypassed or propped open. And it led to the creation of the best-selling class of medications in history: cholesterol-lowering statin drugs, which generate more than $15 billion in worldwide sales every year.
But it’s all a house of cards. No matter what you’ve been led to believe, a high cholesterol level is not a reliable sign of an impending heart attack. In fact, growing numbers of experts question whether cholesterol matters at all. As for statin drugs, for most of the 40-plus million Americans recommended to take them for the rest of their lives, they’re an ineffective, expensive, side effect- riddled fraud.
Statin-Free Zone
When a patient taking Lipitor, Zocor, or another statin drug comes to Whitaker Wellness, we discontinue it at once. “But my cholesterol level is 240.” “My doctor told me I’ll have a heart attack if I don’t take this drug.”My father died of heart disease, so I have to take it.” I’ve heard all these justifications and more, and I still recommend that my patients get off statins. Here’s why.
First, they’re not very effective. These drugs do lower cholesterol, but so what? We’re not treating lab numbers. We’re treating patients, and the ultimate goal in cholesterol management is to reduce risk of cardiovascular disease. Except for a very limited number of people, there is absolutely no evidence that statins protect against heart attack or premature death.
Are you over age 65? Not a single study suggests you’ll receive any benefits, even if your cholesterol goes down substantially. A woman of any age? Same story. A man younger than 65 who has never had a heart attack? Ditto, no help at all. For middle-aged men who have had a heart attack, statins may lower risk of a repeat heart attack, but that’s the extent of it.
I know this is hard to buy in light of the multiple drug advertisements and glowing endorsements from doctors. But keep in mind that pharmaceutical companies do a superb job of pulling the wool over the eyes of consumers and physicians alike by withholding unfavorable study results and making false, misleading, and often deceptive claims.
A Statistic We Can Understand
That’s why I want to step around confusing statistics and tell you about an easy-to-understand measure that you’ll never hear about in drug ads. It’s called “number needed to treat,” or NNT, and it describes the number of patients who would need to be treated with a medical therapy in order to prevent one bad outcome. Experts consider an NNT over 50 to be “worse than a lottery ticket.”
Lipitor ads claim that it reduces risk of heart attack by 36 percent. Sounds pretty good until you look at the fine print, do the math (which John Carey did in a great article in Business Week), and figure out that the drug’s NNT is 100. This means that 100 people must be treated with Lipitor in order for just one heart attack to be prevented. The other 99 people taking the drug receive no benefit.
To put this into perspective, the NNT of antibiotics for treating H. pylori, the underlying cause of stomach ulcers, is 1.1. These drugs knock out the bacteria in 10 out of 11 people who take it, making them a reliable, cost-effective therapy. At the other end of the spectrum are statins, which as a class have an NNT of 250, 500, or higher depending on the study you look at. What a deal for drugs that can cost more than a thousand bucks a year and are almost guaranteed to cause problems.
Goodbye Drugs, So Long Symptoms
Statins lower cholesterol by suppressing the activity of an enzyme in the liver involved in the production of cholesterol. But this enzyme has multiple functions, including the synthesis of coenzyme Q10. CoQ10 is a key player in the metabolic processes that energize our cells. No wonder statin users often suffer from fatigue, muscle pain and weakness, and even heart failure- the cells are simply running out of juice.
The second most frequent adverse effects of statins are problems with memory, mood, suicidal behavior, and neurological issues. Other common complaints include sexual dysfunction, and liver and digestive problems. Symptoms range from minor (achiness, forgetfulness) to serious (complete but temporary amnesia, permanent memory loss) to lethal (congestive heart failure, rhabdomyolysis or complete muscle breakdown). One statin drug, Baycol, was taken off the market a few years ago after it caused dozens of deaths from rhabdomyolysis. Several studies have also linked statin drugs with an increased risk of cancer.
Because physicians rarely warn of these side effects, few patients suspect their drugs may be the reason they begin feeling bad- and it’s often a revelation when they put two and two together. Simply discontinuing these medications can result in tremendous improvements in health and well-being. Texas cardiologist Peter Langsjoen, MD, published a study showing that when symptomatic patients got off their statins and started taking 240 mg of CoQ10 per day, they had significant decreases in fatigue, myalgias (muscle aches), dyspnea (shortness of breath), memory loss, and/or peripheral neuropathy.
Not a Drug But a Program
As you can see, we need to shift away from this myopic focus on statin drugs and lowering cholesterol, and take a more holistic view. Folks, you don’t need statins- you need a program that addresses all the known risk factors for heart attack, stroke, and other cardiovascular disorders.
Inflammation, not high cholesterol, is the primary cause of heart disease. Harvard researchers have discovered that a high blood level of C-reactive protein, a marker of inflammation, is more predictive of heart disease than cholesterol. To get a handle on inflammation, lose weight- especially if you carry excess fat in the abdominal area. Exercise. Stop smoking. Eat plenty of vegetables and several weekly servings of salmon, sardines, and other omega-3 fatty acids, and avoid sugars and starches.
The beauty of this program is that it targets not only inflammation but other conditions that contribute to cardiovascular disease, including high blood pressure, diabetes, even cholesterol. Best of all, it’s a foundation for overall good health.
Necessary Nutrients
Your program should include a well-rounded nutritional supplement regimen, as well. My number-one suggestion for inflammation in all its guises is fish oil. This supplement also improves blood flow, discourages excess clotting, helps normalize heart rhythm, and saves lives by reducing risk of sudden cardiac death.
Folic acid and other B-complex vitamins are important because they lower levels of homocysteine, a toxic substance that damages the arteries. The mineral magnesium relaxes the arterial walls, which improves blood flow, lowers blood pressure, and helps prevent arrhythmias. And antioxidants, such as vitamins C and E, provide protection against damaging free radicals- another contributor to cardiovascular disease.
Supplements that boost the heart’s energy are recommended as well. One is coenzyme Q10. In addition to serving as a potent antioxidant, CoQ10 also increases the heart muscle’s efficiency and protects against the adverse effects of statin drugs. Another is D-ribose, a natural sugar that is the structural backbone of adenosine triphosphate (ATP), the energy that fuels cellular function.
Click here for the full report.
Erectile Dysfunction May Predict Heart Risk
March 16, 2010
Los Angeles Times
By Thomas H. Maugh II
For the first time, researchers have shown that erectile dysfunction is a strong predictor of the likelihood that men will die of heart disease.
Men who suffer from the problem, which some consider more an emotional than a physical issue, are twice as likely to succumb to cardiovascular disease or heart attacks as those who do not have the problem, German researchers reported Monday in Circulation: Journal of the American Heart Assn.
Researchers have known for years that there is a link between erectile dysfunction, commonly abbreviated as ED, and heart disease, said Dr. Sahil Parikh, an interventional cardiologist from University Hospitals Case Medical Center in Cleveland who was not involved in the study. “But now there is pretty clear evidence that there is a substantially increased risk of heart attack and death when patients have erectile dysfunction.”
The results are probably not too surprising, added Dr. Robert Kloner, a cardiologist at USC’s Keck School of Medicine, “because arteries in the penis are smaller, so atherosclerosis shows up there sooner,” perhaps three to four years before the onset of cardiovascular disease.
The take-home message, both experts said, is that when a patient seeks treatment for ED, typically from a general practitioner, he should be given a full physical work-up to look for heart disease and referred to a cardiologist.
“When they are treated aggressively early, we can prevent heart attacks and stroke and they can have many years added to their lives,” Parikh said.
Existing guidelines for treating men with ED from the Princeton Consensus Conference already state that “a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise.” Kloner, a coauthor of those guidelines, said that when the guidelines are updated this year, they will probably carry a stronger recommendation that a patient presenting with ED get a cardiovascular examination.
Dr. Michael Bohm, a cardiologist at Germany’s Saarland University, and his colleagues studied 1,519 men from 13 countries who were involved in a study of two drugs to treat cardiovascular disease. The men were also queried about their ED at the beginning of the study, two years into it and at the end at five years. A full 55% of the men had ED at the beginning of the trial, nearly double the normal incidence of about 30% in the population at large.
The team reported that, in the five years of follow-up, men with ED were 1.9 times as likely to die from heart disease, twice as likely to have a heart attack, 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. The risks increased with the severity of the ED.
Disappointingly, the two drugs tested in the study, ramipril and telmisartan, did not improve the course of the ED.
That’s not surprising, said Dr. Peter Pelikan, a cardiologist at Saint John’s Health Center in Santa Monica, “because it takes years and years and years to get any resorption of cholesterol” that would reduce blockage of the penile arteries. “The study was too small and too short to see that.”
Many men with ED see a general practitioner or a urologist to get treatment and are prescribed drugs like Viagra or Cialis, Bohm said in a statement. “The drug works and the patient doesn’t show up any more. These men are being treated for ED, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk.”
Click here for the full report.
Vitamin D Deficiency Becoming an Epidemic
March 15, 2010
Natural News
By Mike Adams
There is an epidemic of vitamin D deficiency sweeping across our modern world, and it’s an epidemic of such depth and seriousness that it makes the H1N1 swine flu epidemic look like a case of the sniffles by comparison. Vitamin D deficiency is not only alarmingly widespread, it’s also a root cause of many other serious diseases such as cancer, diabetes, osteoporosis and heart disease.
A new study published in the March, 2010 issue of the Journal of Clinical Endocrinology and Metabolism found that a jaw-dropping 59 percent of the population is vitamin D deficient. In addition, nearly 25 percent of the study subjects were found to have extremely low levels of vitamin D.
Lead author of the study, Dr. Richard Kremer at the McGill University Health Center, said “Abnormal levels of vitamin D are associated with a whole spectrum of diseases, including cancer, osteoporosis, and diabetes, as well as cardiovascular and autoimmune disorders.”
This new study also documents a clear link between vitamin D deficiency and stored body fat. This supports a theory I’ve espoused here on NaturalNews for many years: That sunshine actually promote body fat loss. Vitamin D may be the hormonal mechanism by which this fat loss phenomenon operates.
The research findings on vitamin D, by the way, get even better…
Activator for the immune system
Recent research carried out at the University of Copenhagen has revealed that vitamin D activates the immune system by “arming” T cells to fight off infections.
This new research, led by Professor Carsten Geisler from the Department of International Health, Immunology and Microbiology at the University of Copenhagen, found that without vitamin D, the immune system’s T cells remain dormant, offering little or no protection against invading microorganisms and viruses. But with vitamin D in the bloodstream, T cells become “armed” and begin seeking out invaders that are then destroyed and carried out of the body.
Vitamin D, in other words, acts a bit like the ignition key to your car: The car won’t run unless you turn the key and ignite the engine. Likewise, your immune system won’t function unless it is biochemically activated with vitamin D. If you’re facing the winter flu season in a state of vitamin D deficiency, your immune system is essentially defenseless against seasonal flu. That’s why all the people who get sick are the ones who live indoors, work indoors and exist in a chronic state of vitamin D deficiency.
That’s also why virtually all the people who died from H1N1 were chronically deficient in vitamin D. They had virtually no immune system protection at all and were thus easy targets for the swine flu.
These findings about vitamin D “arming” the immune system were published in Nature Immunology. Commenting on the findings, the researchers said, “Scientists have known for a long time that vitamin D is important for calcium absorption and the vitamin has also been implicated in diseases such as cancer and multiple sclerosis, but what we didn’t realize is how crucial vitamin D is for actually activating the immune system — which we know now.” (UK Telegraph, source below).
It seems the CDC and WHO remain utterly ignorant about this research or they would have been recommending vitamin D to fight the recent H1N1 pandemic rather than vaccine shots. Vitamin D would have been a far more effective (and less costly) defense against the pandemic than vaccine shots, especially given that even vaccines don’t work unless there is an immune response, and that immune response requires the presence of vitamin D!
And while vaccine shots have undesirable side effects such as causing severe neurological damage in a small number of vaccine recipients, vitamin D’s only significant “side effect” is that it prevents 77% of all cancers, too.
The common denominator for disease
What’s becoming increasingly clear from all the new research is that vitamin D deficiency may be the common denominator behind our most devastating modern degenerative diseases. Kidney failure patients are almost universally deficient in vitamin D and diabetes patients are usually in the same category. People suffering from cancer almost always demonstrate severe vitamin D deficiency, as do people with osteoporosis and multiple sclerosis.
Click here for the full report
Russia Banning U.S. Chicken
March 15, 2010
Natural News
By E. Huff
Beginning on January 1, 2010, Russia has officially banned imported poultry products from countries that use chlorine in their processing methods. Russian Prime Minister Vladimir Putin announced that Russia will no longer allow chicken imports from the U.S. because the chlorine baths used to sanitize chickens do not meet Russian food safety standards.
Since it comes from Russia, many may dismiss the ban as being politically charged with no scientific validity. However many nations around the world, including all within the European Union, have banned poultry imports from chlorine-using countries because of the dangers posed by the chemical. These countries use different methods to disinfect meat, including air chilling and electrolyzed water treatments, which do not expose the meat to harmful chemicals.
Putin expressed that Russia is working to become poultry self-sufficient by the year 2015 but, until then, will import only from nations that do not use chlorine in meat processing. Each year, the import quota will be dropped until, eventually, all chicken will be domestically raised in Russia.
When the issue first surfaced back in 2008, the U.S. Poultry & Egg Export Council tried to persuade Russia that the chlorine treatment methods used on chicken are both safe and effective. According to the U.S. Department of Agriculture (USDA), the hypochlorus chemical used, which is an active form of chlorine, is an effective antimicrobial.
Rather than reconsider the safety of its own treatment methods, U.S. regulators tried to use rhetoric to convince Russia to accept U.S. imports and failed miserably. Russia refused to hear any of it, ending $825 million worth of U.S. chicken imports into its country.
The truth about chlorine chicken baths is that not only are they not truly effective but they expose people to a steady stream of toxic chlorine every time they consume chicken. Chlorine is known to increase cancer risk and cause other serious problems including respiratory illness and heart disease. Like other environmental halogens, chlorine contributes to thyroid dysfunction as well.
The levels of chlorine used in chicken baths, which average somewhere between 20 and 50 parts per million (ppm), do not always kill all the pathogens present. According to a European Consumers’ Organization study conducted in 2007, 83 percent of U.S. chicken that had been treated in chlorine baths still contained harmful pathogens. The bath essentially becomes a pathogen cesspool that contaminates all the other chickens that are submerged in it.
It is no wonder that Russia, the E.U., and a growing list of nations around the world are refusing chlorinated U.S. chicken.
Click here for the full report
The True Price of Health Care Spending
March 15, 2010
Natural News
By David Gutierrez
The U.S. healthcare system loses between $505 and $850 billion a year to mistakes, inefficiency and fraud, according to a report by Thomson Reuters. This amounts to one-third of all national healthcare spending.
“America’s healthcare system is indeed hemorrhaging billions of dollars,” the report says.
According to the report, unnecessary medical procedures and treatments — including antibiotic overuse and superfluous tests — account for 37 percent of all wasted spending, $200 to $300 billion per year. Fraud — including false Medicare claims and kickbacks for referrals or prescriptions — accounts for another 22 percent, as much as $200 billion a year. Medical errors are responsible for 11 percent of excess spending, or $50 to $100 billion yearly. Preventable health problems, such as diabetes, cost the healthcare system $30 to $50 billion per year.
One of the easiest areas to repair might be administrative inefficiency, which accounts for a full 18 percent of medical overspending.
“The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada,” the report says. “American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada.”
Administrative inefficiency can also lead to other wasteful practices.
“It is waste when caregivers duplicate tests because results recorded in a patient’s record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed,” the report says.
Although the United States has the highest per capita healthcare spending and spends a higher proportion of its GDP on healthcare than any other nation in the Organization for Economic Co-operation and Development (a group of predominantly high income Western democracies), it has the highest rates of heart disease, obesity, diabetes and neonatal death in the developed world, as well as the unhealthiest population.
Click here for the full report
Study Shows Americans are Being Overtreated
March 15, 2010
Associated Press
By Lindsey Tanner
CHICAGO — Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system.
Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?
A combination of both is at work, but new evidence and updated guidelines are recommending a step back and more thorough doctor-patient talks about risks and benefits of screening tests.
Americans, including the commander in chief, need to realize that “more care is not necessarily better care,” wrote cardiologist Dr. Rita Redberg, editor of Archives of Internal Medicine. She was commenting on Obama’s recent physical.
His exam included prostate cancer screening and a virtual colonoscopy. The PSA test for prostate cancer is not routinely recommended for any age and colon screening is not routinely recommended for patients younger than 50. Obama is 48. A White House spokesman noted that earlier colon cancer screening is sometimes recommended for high-risk groups, such as African-Americans.
Doctors disagree on whether a virtual colonoscopy is the best method. But it’s less invasive than the traditional procedure and doesn’t require sedation — or the possible temporary transfer of presidential power, the White House said.
Yet Redberg, a doctor with expertise in health policy, takes issue with that test and a heart scan to look for calcium deposits in the president’s arteries. She said the calcium check isn’t recommended for low-risk men like Obama.
And the colon exam exposed him to radiation “while likely providing no benefit to his care,” she wrote in an editorial in the medical journal. Obama’s experience “is multiplied many times over” at a huge financial cost to society, and to patients exposed to potential harms but no benefits.
“People have come to equate tests with good care and prevention,” said Redberg, of the University of California at San Francisco Medical Center. “Prevention is all the things your mother told you — eat right, exercise, get enough sleep, don’t smoke — and we’ve made it into getting a new test.”
This week alone, a New England Journal of Medicine study suggested that too many patients are getting angiograms — invasive imaging tests for heart disease — who don’t really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section.
Last week, the American Cancer Society cast more doubt on routine PSA tests for prostate cancer. And a few months ago, other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer.
Experts dispute how much routine cancer screening saves lives. It also sometimes detects cancers that are too slow-growing to cause harm, or has false-positive results leading to invasive but needless procedures — and some risks. Treatment for prostate cancer that may be too slow-growing to be life-threatening can mean incontinence and impotence. Angiograms carry a slight risk for stroke or heart attack.
Not all doctors and advocacy groups agree with the criticism of screening. Many argue that it can improve survival chances and that saving even a few lives is worth the cost of routinely testing tens of thousands of people.
Dr. Peter Pronovost, a Johns Hopkins University patient safety expert, said routine testing is often based on bad science, or on guidelines that quickly become outdated as new science emerges.
The recent shift in focus reflects evolving research on the benefits and risks of screening.
While some patients clearly do benefit from screening, others clearly do not, said Dr. Richard Wender, former president of the American Cancer Society.
These include very old patients, who may unrealistically fear cancer and demand a screening test, when their risks are far higher of dying from something else, Wender said.
“Sometimes it’s kind of the path of least resistance just to order the test,” he said.
Doctors also often order tests or procedures to protect themselves against lawsuits — so-called defensive medicine — and also because the fee-for-service system compensates them for it, said Dr. Gilbert Welch, a Dartmouth University internist and health outcomes researcher.
Some doctors think “it’s always a good thing to look for things to be wrong,” Welch said. It also has become much easier to order tests — with the click of a mouse instead of filling out forms, and both can lead to overuse, he said.
While many patients also demand routine tests, they’re often bolstered by advertisements, medical information online — and by doctors, too, Welch said.
“To some extent we’ve taught them to demand these things,” he said. “We’ve systematically exaggerated the benefits of early diagnosis,” which doesn’t always improve survival. “We don’t always tell people there might actually be downsides” to testing.
Jennifer Traig, an Ann Arbor, Mich., author of a book about hypochondria, says patients like her often think, “I’m getting better care if we’re checking for more things.”
Traig has had many costly high-tech tests, including an MRI and several heart-imaging tests, for symptoms that turned out to be nothing. She thinks doctors were right to order those tests, but that counseling could have prevented her from “wasting resources” and getting tests it turned out she didn’t need.
The new guidance from the cancer society last week on PSA testing, echoing others’ advice on mammograms, is for doctors and patients to thoroughly discuss testing, including a patient’s individual disease risks, general pros and cons of testing and possible harms it may cause.
Dr. Bruce Minsky, a University of Chicago cancer specialist who still favors routine mammograms for women in their 40s, said that emphasis is a positive trend.
“That to me is one of the greatest benefits,” he said. “It enhances that communication between the physician and patient.”
FDA Adds Boxed Warning To Plavix On Effectiveness
March 15, 2010
Reuters
By Lisa Richwine and JoAnne Allen
The Food and Drug Administration said it was adding a new boxed warning to Plavix, an $8-billion-a-year drug sold by Bristol-Myers Squibb Co and Sanofi-Aventis SA.
The new language will “warn about reduced effectiveness in patients who are poor metabolizers of Plavix,” the FDA said in a notice on its website.
Poor metabolizers are people whose bodies do not effectively convert Plavix to its active form.
“Because the patient makes less of the active form there is less anti-platelet effect in the blood and the patient may not receive the full benefit of Plavix treatment,” Mary Ross Southworth of the FDA’s Center for Drug Evaluation and Research told reporters in a teleconference.
An estimated 2 percent to 14 percent of the population are poor metabolizers of Plavix, the FDA said.
Bristol said published studies suggested the percentage of poor metabolizers is approximately 3 percent. “Patients should continue taking Plavix unless told to do otherwise by their healthcare professional,” the company said in a statement.
The new warning will advise doctors of genetic tests that can identify those patients and to consider alternatives for them.
The length of time it takes to get results of the genetic tests and costs will vary depending on the laboratories used, but the tests are expected be priced under $500, FDA officials said.
Plavix is the second-best selling drug in the world. It loses patent protection in 2012.
Researchers have been studying an alternative drug for patients who cannot benefit from Plavix and details of their findings are expected to be released at a meeting of heart specialists next week.
Plavix reduces the risk of heart attack, unstable angina, stroke, and cardiovascular death in patients with heart disease by making platelets less likely to form blood clots.
Plavix does not have its anti-platelet effects until it is metabolized into its active form by the liver enzyme, CYP2C19.
Information about poor metabolizers and diminished effectiveness was first included in the Plavix label in May, 2009, officials said.
“Since that label was approved, further evidence has accumulated to support evidence of an association between CYPC219 type, Plavix exposure and poor treatment outcomes,” Southworth said.
“After reviewing all of that data, we felt like we probably needed to strengthen the warning to include that the provider should consider alternative treatment strategies.”
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Diabetes Heart Treatments May Cause Harm
March 15, 2010
The New York Times
By Gina Kolata
Three aggressive treatment strategies doctors had expected would prevent heart attacks among people with Type 2 diabetes and some who are the verge of developing it have proved to be ineffective or even harmful, new studies show.
The results are surprising and disappointing, heart and diabetes experts say. An estimated 21 million Americans have Type 2 diabetes, the kind once known as adult-onset, and they are at enormous risk for heart disease. The only measures proved to reduce their chances — avoiding cigarettes and taking medication to lower bad cholesterol and blood pressure — still leave diabetics with a heart attack risk equivalent to that of a nondiabetic who has already had a heart attack.
So doctors began trying other strategies they hoped would help: getting blood pressure to a normal range; raising levels of good cholesterol and lowering levels of dangerous triglycerides; or modulating sharp upswings in blood sugar after a meal.
It is not known how many doctors have been encouraging patients to take these measures, but medical specialists say it seemed reasonable and tempting to do so.
“Doctors always want to improve the lives of their patients, and that often leads to pressure to treat more and more,” said Dr. Henry N. Ginsberg, director of the Irving Institute for Clinical and Translational Research at Columbia University. The new studies, he says, could save a lot of people from taking drugs that will not help them.
The papers were presented at an American College of Cardiology meeting on Sunday and are being published online by The New England Journal of Medicine.
In Type 2 diabetes, the body is resistant to the hormone insulin, leading to abnormally high blood sugar levels that can cause eye, kidney and nerve disease. But heart disease is what kills most patients. A quarter to a third of heart attack patients have diabetes, even though diabetics constitute just 9 percent of the population. And 25 percent of heart attack patients are on the verge of diabetes, with abnormally high blood sugar levels.
High blood sugar levels themselves increase the risk of heart disease, but researchers found two years ago that rigorously controlling blood sugar did not prevent heart disease or deaths in people with Type 2 diabetes. Researchers said the failure was probably because most of those patients also had other problems that made their odds of heart disease soar, like high levels of LDL cholesterol, low levels of HDL cholesterol, high levels of triglycerides and high blood pressure. And most were older and overweight.
Type 2 diabetes “captures all these risk factors in one patient,” said Dr. David Nathan, director of the diabetes center at Massachusetts General Hospital.
It seemed logical to look at the other risk factors. One large federal study asked if getting high blood pressure down to a level considered normal, a systolic pressure of no more than 120, would help protect diabetics from heart disease and save lives.
This hypothesis was promising because studies that observed populations found that heart disease and stroke risk increase continuously as systolic blood pressure rises from 115 on up, said Dr. William C. Cushman, a study investigator and chief of the preventive medicine section at the Veterans Affairs Medical Center in Memphis.
To put the idea of a normal blood pressure to the test, half of the study’s 4,773 participants took drugs to get their systolic blood pressure to 120 or below. The rest had a blood pressure goal of less than 140.
But lower blood pressure did not prevent heart attacks or cardiovascular deaths, and those with lower blood pressure were more likely to suffer severe side effects from the drugs, like high potassium levels or dangerously low blood pressures. They also took an average of 3.4 drugs to lower blood pressure, compared with an average of 2 drugs for those with the higher pressure.
A second, less rigorous study, involving 6,400 patients with Type 2 diabetes and heart disease, asked whether getting systolic blood pressure lower than 130 was any better than getting it to 130 to 140. It found that patients actually were worse off: those with the lower blood pressure ended up with a 50 percent greater risk of strokes, heart attacks or deaths.
National blood pressure treatment guidelines call for a systolic pressure of 130 or lower. That was based on expert opinion and observational studies, Dr. Cushman said. Now, he said, it is likely to be reconsidered when the group that sets the guidelines prepares a report this year.
People with diabetes also tend to have low levels of HDL cholesterol and high levels of triglycerides, a combination known to increase the risk of heart disease. And in some studies, treating that combination with a type of drug called a fibrate reduced risk in diabetics and nondiabetics who were not taking statins. So it made sense to see if fibrates also helped Type 2 diabetics who were taking statins.
It did not, concluded another arm of the federal study involving 5,518 people with Type 2 diabetes.
“It’s a disappointment,” said Dr. Ginsberg, a lead study investigator. “But it’s very, very important,” because it says most people will not be helped by taking the additional drug.
It means, said Dr. Denise Simons-Morton of the National Heart, Lung and Blood Institute, the project officer for the federal study, that “doctors and patients now know that the inclination to do intensive treatment that people seemed to think would be better for cardiovascular risk reduction wasn’t better.”
A final studyinvestigated the popular hypothesis that rapid rises in blood glucose after a meal were dangerous and could lead to heart disease. Many doctors were giving drugs assuming the hypothesis was correct, Dr. Nathan said.
“Every meeting you go to, some academic is talking about how postprandial hyperglycemia is really bad and that you should aim specifically to get it lower,” Dr. Nathan said. The study, he said, “is a direct test of that.”
The study, which involved 9,300 patients at high risk for diabetes because their blood sugar was high, tested the drug nateglinide, which enhances insulin secretion. It also tested a blood pressure drug. Neither decreased heart disease risk.
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