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.
More People Dying Of Infections Acquired At Hospitals
February 23, 2010
Reuters
Pneumonia and blood-borne infections caught in hospital killed 48,000 patients and cost $8.1 billion in 2006, according to a report released on Monday.
The study is one of the first to put a price tag on the widespread problem, which is worsening and which some experts say is adding to the growing cost of healthcare in the United States.
“In many cases, these conditions could have been avoided with better infection control in hospitals,” said Ramanan Laxminarayan of Resources for the Future, a think tank that sponsored the study.
Sepsis — a blood infection — killed 20 percent of patients who developed it after surgery, Laxminarayan and colleagues reported in the Archives of Internal Medicine.
They studied hospital discharge records from 69 million patients at hospitals in 40 U.S. states between 1998 and 2006, looking for two diagnoses — hospital-acquired pneumonia and sepsis.
Patients who developed sepsis after surgery had to stay in the hospital on average nearly 11 days extra, at a cost of $32,900 per patient, they found. And just under 20 percent of them died.
Pneumonia patients stayed an extra 14 days after surgery, at a cost of $46,400 and more than 11 percent of them died, the researchers found.
“That’s the tragedy of such cases,” said Anup Malani of the University of Chicago, who worked on the study.
“In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control and they can die.”
The researchers said that 1.7 million healthcare-associated infections are diagnosed every year.
Many are due to drug-resistant bacteria, such as methicillin resistant Staphylococcus aureus or MRSA, which cost more to treat because only a few drugs can work against them. These infections can also be caught outside hospitals and some studies show that such community-acquired infections are also on the rise.
One estimate from Pfizer Inc suggested that treating MRSA alone cost $4 billion a year.
Measures to prevent infection are simple and include careful handwashing, hygiene and screening patients when they check in. However, these measures are difficult to enforce, many studies have found.
Click here for the full report.
San Francisco’s Toxic Biosolids Good For You?
February 12, 2010
PR Watch
By Organic Consumer Association
Fifteen years ago, CMD’s book Toxic Sludge Is Good for You! first exposed the hidden government and industry PR campaign greenwashing toxic sewage sludge as “biosolids,” an invented PR euphemism used to cynically re-brand toxic waste as “fertilizer” given free to farmers. Today, unfortunately, the biosolids scam is bigger than ever. The Organic Consumers Association (OCA) reports that “San Francisco has come up with an ingenious plot to trick city residents into taking their toxic sewage sludge back and disposing of it in their own gardens. San Francisco is having Synagro, the corporate giant of the toxic sludge industry, ‘compost’ some of the toxic sewage sludge. Then they give it away to San Francisco’s gardeners telling us it’s ‘high-quality, nutrient-rich, organic Biosolids Compost.’ ” OCA has launched a grassroots campaign calling on San Francisco’s mayor to stop the practice, noting “municipal sewage sludge routinely contains thousands of dangerous pathogens, toxic heavy metals, flame retardants, endocrine disruptors, carcinogens, pharmaceutical drugs and other hazardous chemicals coming from residential drains, storm water runoff, hospitals, and industrial plants.”
Click here for the full report
Psychiatric Drugs Being Prescribed to Dementia Patients For Profit
February 8, 2010
Natural News
By David Gutierrez
Elderly dementia patients are being subjected to “scandalous abuse” by being drugged with dangerous antipsychotic drugs, according to a letter by ten influential health organizations, published in The Daily Telegraph.
“[One hundred thousand] people with dementia in care homes are being inappropriately prescribed a damaging chemical cosh of antipsychotic drugs and new research suggests that there is a significant problem in hospitals too,” the letter reads. “Antipsychotics should only ever be a last resort. This over prescription is abuse and it must stop. … We cannot stand by while this scandalous abuse of vulnerable citizens continues.”
Although antipsychotic drugs are intended for people with medical conditions such as schizophrenia and bipolar disorder and are not approved for the treatment of dementia, studies show that nursing homes and hospitals regularly prescribe them to these patients as sedatives, in order to make them easier for doctors and nurses to handle.
Research has shown, however, that antipsychotic drugs can double a patient’s risk of death if used for three years. Another study found that dementia patients are three times more likely to suffer a stroke if given antipsychotic drugs.
A 2008 report by British Minister of Parliament Paul Burstow concluded that 23,500 dementia patients are being killed every year by inappropriate prescription of antipsychotics in nursing homes. However, a recent survey by the Alzheimer’s Society marks the first time that researchers have looked into the prevalence of the problem in hospitals.
The trust found that three-quarters of nurses surveyed said they had seen antipsychotics used to sedate dementia patients, while one-quarter said they had seen the drugs used inappropriately.
“The massive over prescription of antipsychotics to people with dementia is an abuse of human rights, causing serious side effects and increasing risk of death,” said Neil Hunt of the Alzheimer’s Society. “The government must take action to ensure that these drugs are only ever used as a last resort.”
“While the Department of Health prevaricates, thousands of people are being put at risk through the misuse of antipsychotics,” said Rebecca Wood of the Alzheimer’s Research Trust.
Click here for the full report.
The Kevin Trudeau Show: 2-3-10
Today, Kevin educates you on the scary facts behind MSG’s and how many excitotoxins you are putting in your body just by eating a can of soup!
The MSG Report
Cocaine Found in Water Supply
Rocket Fuel in Nation’s Drinking Water
World Economic Forum’s Security Chief Found Dead After ‘Suicide’
Doctors Are Addicted To Every Drug Under The Sun
Bill Gates in Vaccine Game
UK Hospitals Tried to Gag Whistleblowers
Man Boob Reduction Surgeries on the Rise
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Disinfectants Helping Germs Evolve into Superbugs
January 06, 2010
Natural News
By S. L. Baker
The opportunistic bacterium Pseudomonas aeruginosa is increasingly recognized as a cause of severe nosocomial infections — those are infections people contract as a result of treatment in a hospital or other medical center. In fact, a Pseudomonas aeruginosa infection can be life-threatening, especially if someone is immunocompromised.
The germ also causes chronic infections in cystic fibrosis patients. So it’s no surprise that disinfectants are widely sprayed, sloshed and wiped over surfaces in medical settings to supposedly protect patients. But now comes evidence the very act of relying on disinfectants to prevent Pseudomonas aeruginosa infections could be turning the already dangerous germ into a superbug that’s resistant to antibiotics as well as the disinfectant itself.
Germs adapt to survive
For a study just published in the January issue of the journal Microbiology, researchers from the National University of Ireland in Galway took laboratory cultures of Pseudomonas aeruginosa and added increasing amounts of disinfectant to the bacteria. They found this caused the germs to adapt over time so they could survive the disinfectant.
But something else also happened when the bacteria were exposed to the disinfectant. Remarkably, the germs became resistant to ciprofloxacin, a strong antibiotic widely-prescribed to fight Pseudomonas aeruginosa. And the germs became resistant to the drug even though they weren’t exposed to it.
How could this be possible? The scientists discovered that when exposed to the disinfectant, the bacteria adapted to more efficiently pump out antimicrobial agents (both the disinfectant and antibiotics) from the germ’s cells. The researchers also found the bacteria’s adaptation resulted in a DNA mutation that allowed the Pseudomonas aeruginosa microbes to specifically become immune to ciprofloxacin-type antibiotics.
Dr. Gerard Fleming, who headed the research team, warned in a media statement that the study results could mean “… residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria. What is more worrying is that bacteria seem to be able to adapt to resist antibiotics without even being exposed to them.”
Obviously, if disinfectants used to kill bacteria on surfaces to prevent their spread are actually making the germs stronger so they survive and go on to infect patients — and if antibiotics used to treat these infections are no longer effective — the results could be a serious threat to hospitalized patients. Dr. Fleming added that it is important for scientists to zero in on environmental factors that might promote antibiotic resistance, thereby creating superbugs.
“We need to investigate the effects of using more than one type of disinfectant on promoting antibiotic-resistant strains. This will increase the effectiveness of both our first and second lines of defense against hospital-acquired infections,” he stated.
Readmission to Hospitals Blamed on Drug Side Effects
January 5, 2010
Natural News
By David Gutierrez
One in every five patients readmitted to the hospital within a year of an inpatient treatment ends up there because of an adverse drug reaction, according to a study conducted by researchers from the Royal Liverpool and Broadgreen University Hospitals NHS Trust.
The research was presented at the British Pharmaceutical Conference in Manchester and published in the Journal of Pharmacy and Pharmacology.
“While medicines have lots of benefits, they can also have harmful side-effects resulting in re-admission to hospital” researcher Emma Davies said. “Managing this involves checking patients’ medicines while they are in hospital and regularly reviewing prescriptions in primary care after patients are discharged.”
Researchers examined data from approximately 1,000 patients who had been admitted to a large Liverpool hospital. Among the 290 patients who were readmitted within one year and for whom data were available, 21 percent had been readmitted at least partly because of an adverse drug reaction.
The researchers defined an adverse drug reaction as “an appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product.”
After analyzing each case, the researchers concluded that 57 percent of the adverse drug reactions probably or definitely could have been prevented. The most common side effects resulting in readmission were reactions to aspirin (prescribed to prevent heart attacks or strokes) or diuretics (prescribed for the treatment of high blood pressure or heart failure).
Not all drug reactions in the study caused hospital readmission, but all required medical treatment. A total of 73.3 percent were classified as low severity, necessitating only minor treatment; 24.7 percent were classified as moderate, requiring a moderate increase in treatment but causing no lasting damage; 1.91 percent were classified as severe, causing permanent harm, and 0.14 percent were catastrophic, directly leading to a patient’s death.
Click here for the full report
Defense Contractors Got Flu Vaccine Before Schools and Hospitals
December 9, 2009
The Raw Story
By Daniel Tencer
Corporate offices at defense contractors and energy companies in Texas received doses of swine flu vaccine at a time when the vaccine was in short supply and the state’s hospitals and schools were receiving none, says a news report published Tuesday.
USA Today reports that Bell Helicopter received 100 doses and Lockheed Martin Aeronautics received 80 doses in October or early November, when the vaccine was scarce. Energy companies Chevron (190 doses) ExxonMobil (160 doses), Dow Chemical (170 doses) and ConocoPhillips (110 doses) also received shipments the newspaper says were destined for the companies’ corporate clinics.
“Thousands of registered providers — doctors, hospitals, schools, pharmacies — in Texas alone got no doses in that period,” USA Today reports
A memorandum circulated in October by Lockheed Martin indicates the company either did not expect to receive the H1N1 vaccine, or was keeping its corporate supply a secret from the rank-and-file.
“A limited supply of H1N1 vaccine is expected to be available from public health authorities in mid-October for high-risk individuals, but corporations including Lockheed Martin are not expected initially to have the vaccine to provide directly to employees,” the memorandum stated.
Corporate Employers Got Scarce Flu Vaccine
December 8, 2009
USA Today
By Alison Young
When the swine flu vaccine was most scarce, health officials gave thousands of doses to corporate clinics at Walt Disney World, Toyota, defense contractors, oil companies and cruise lines, according to a USA TODAY review of vaccine distribution data from three states.
USA TODAY examined how state health departments distributed H1N1 vaccine after public outcry last month over Wall Street firms such as Goldman Sachs receiving doses while doctors and hospitals encountered shortages. The data show other companies got the vaccine in October and early November. In some cases, early doses went to people not deemed most at risk by the Centers for Disease Control and Prevention.
“Now we have evidence of what my suspicions were,” said U.S. Rep. Frank Pallone, D-N.J., chair of a House health subcommittee. “I’m afraid when you have these corporate initiatives, it’s not primarily needs-based.”
Pallone said he would send the CDC a letter Tuesday asking it to revise guidelines to states on the use of corporate health clinics.
Each state health department must decide how to provide the vaccine to people most at risk, and employers are a legitimate venue, said Anne Schuchat, the CDC’s immunization director. CDC’s priority groups include pregnant women, people with chronic health conditions, health care workers and people ages 6 months to 24 years. “This is much less about what you do for a living and much more about how do you get the vaccine in the path of those target populations,” she said.
The Toyota Family Health Center in San Antonio, which got 2,120 doses, initially focused on the CDC’s priority groups, but since Nov. 16 has offered the vaccine to any employee, contractor or family member, spokesman Craig Mullenbach said.
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Norwegian Cruise Line in Miami used its 300 doses “to vaccinate critical on-board staff on our ships,” spokeswoman AnneMarie Mathews said. She said recipients included medical staff, youth counselors and “key officers responsible for the safe operation of the vessel” but did not address how the counselors and officers fit into CDC’s priority groups.
Of the 2.42 million doses in Texas and 2 million in Florida distributed through mid-November, fewer than 1% went to employers, according to USA TODAY’s analysis of data obtained under state open-records acts. Thousands of registered providers — doctors, hospitals, schools, pharmacies — in Texas alone got no doses in that period.
Among companies that requested and received early doses and say they administered them to high-risk people:
Click here for the full report
Post Surgical Blood Clots More Common Than Originally Thought
December 7, 2009
Reuters
Blood clots can form when patients cannot move for significant periods of time, and for other reasons. Such clots can grow and travel to the lungs, where they can become life-threatening. Doctors can prescribe medications and compression stockings, among other measures, to prevent them.
Earlier studies have suggested that surgery ups the risk as much as 22 times. But in the current study, the risk of such blood clots in the first 6 weeks after inpatient surgery was nearly 70 times higher than it was for those who did not undergo surgery.
And the risk remained higher than average for at least 12 weeks after surgery, study co-author Dr. Sian Sweetland, from the University of Oxford, UK, and colleagues note in the December 4th Online First issue of the journal the BMJ.
Excluding women who had already had a blood clot, as well as those with a history of cancer – which can increase the clotting risk – left almost 950,000 middle-aged subjects in the study. About 240,000 had surgery during the six years in which they were followed, and about 5,400 were admitted to the hospital for blood clots.
Another 270 women died of such clots, autopsies confirmed.
Those who had inpatient surgeries – about 90,000 women – were much more likely to have clots than those who had outpatient surgeries. In the first 6 weeks following surgery, hip and knee replacements had the highest risk, while gynecology procedures had the lowest.
The new findings are “a wake-up call to all surgeons,” Dr. Alexander T. Cohen, from King’s College Hospital, London, writes in a related editorial. In particular, he notes, doctors should consider taking preventive measures for longer than they typically do, for more patients.
Click here for the full report
