“When diet doesn’t work”

Here is a graphic illustration of the concept of moral hazard as applied to the drug treatment of lifestyle diseases.

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Reprinted from AdWatch

Many studies confirm that doctors’ behaviour can be influenced by drug advertising, but many of them are unaware of this.
Not only the advertising text, but also the images play an important part.
See below, for instance, the image in the Lescol advertisement published in the April 2008 issue of Rivista SIMG (Journal of the Italian Society of General Practitioners).

Lescol (fluvastatin sodium) is one of the statin class of drugs used to treat of high cholesterol when diet and other lifestyle changes don’t work.
The Summary of Product Characteristics states “for best results in lowering cholesterol, it is important that you closely follow the diet suggested by your doctor”.

What kind of advice could the doctor have given the two people on the beach?

They seem to be really happy and relaxed. The pastel colours, the calm sea and the blue sky in the background convey the impression that all is going well and no changes are needed.

The designer must have been influenced by the Colombian painter Fernando Botero, famous for his fat men and women, who generally emanate a sense of calmness and satisfaction.

What I can understand, as a doctor, after looking at this image?
“It doesn’t matter what I advise my patients to eat; it isn’t worth them trying to change their lifestyle behaviours.
Only the pill can make the difference!”

OBSTAT-Doctors being paid to push drug study

“Dr. LeLorier reports having served as a paid speaker or consultant for the following manufacturers of statins: Merck Frosst Canada, Pfizer Canada, AstraZeneca, and Bristol-Myers Squibb.” Why would anyone take any advice on statins from him?

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Doctors being paid to push drug study
BY TOM BLACKWELL
National Post
03 Apr 2009

Quebec doctors are being offered $100 for every new patient they put on cholesterollowering statin drugs as part of a major, federally subsidized study that is raising questions about the influence of the pharmaceutical industry on health…read more…

Tech Tags: National Post newspaper Canada

Drug Marketing by “Study”

Cardiac disease threatens diabetics

Dr. Terrence Ruddy, chief of cardiology at the University of Ottawa Heart Institute, says the increasing number of people with diabetes is a major concern across the medical profession.

“The increasing number with diabetes is directly related to the increasing number with obesity,” he says. “We have an epidemic of obesity in young and older people. In older people, that is giving them diabetes now. In younger people, it will give them diabetes in the next 20 to 40 years.” It’s vital to reduce obesity, “not just for 40- to 50-year-olds but in 10 to 20-year-olds,” he says. “We need more money flowing into educational programs focused on lifestyle changes — increased activity, appropriate diet and weight loss in young people. Decrease obesity to decrease diabetes.”

Yet at least 500 cardiologists around the world were paid by AstraZeneca to take part in JUPITER, a clinical “trial” of Crestor in which most subjects were overweight or obese and NO attempt was made to reduce their weights. 1.5% per year became diabetic due to their inflamed excess visceral fat. Probably at least US$500 million flowed into this “trial” with NO “educational programs focused on lifestyle changes”.

Doctors pay lip service to the need to fight obesity but money talks. Those cardiologists probably received at least $1000 per subject to enroll them in the JUPITER “trial”. Why would they dare to insist upon lifestyle change first before enrolling the subject and forgo this income? Members of the “JUPITER Study Group” presumably overseeing the “trial” for AstraZeneca were probably paid $100,000 each for their “consultation”. Why would they insist on lifestyle change first before agreeing to participate?

 

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Cardiac disease threatens diabetics
IRIS WINSTON CANWEST NEWS SERVICE
The Gazette
26 Nov 2008

Just one year after Dale Frayling was diagnosed with type 2 diabetes, he suffered his first heart attack. Four months later, he had a second, more severe attack followed by bypass surgery. That was 11 years ago. The Saskatoon resident, now 57, has…read more…

 

Also blogged here: 1, 2

Tech Tags: The Gazette newspaper Healthy Living

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Here is the list of the cardiologists paid to participate in the JUPITER study who care more about money than advising patients on the best way to prevent atherosclerosis and diabetes.

Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., Robert J. Glynn, Sc.D., for the JUPITER Study Group

Appendix. JUPITER Clinical Sites

Argentina 253: Altamirano J, Berrizbeitia M, Boskis P, Colombo H, Cuadrado J, Cuneo
C, Diaz M, Esper R, Fernandez A, Foye R, Hershson A, Kuschnir E, La Greca R,
Lorenzatti A, Lozada A, Luciardi H, Luquez H, Maffei L, Majul C, Marin M, Muntaner
J, Nul D, Paolasso E, Rey R, Rodenas P, Rodriguez P, Rojas C, Telsolin P, Vita N,
Belgium 487: Adrianes G, Argento O, Bacart P, Baeck L, Baguet J, Balthazar Y, Battello
G, Behets J, Beke P, Bemden S, Berwouts P, Boermans P, Bolly F, Borms J, Boulad M,
Boulanger L, Bous J, Boxstael R, Brands Y, Buyse L, Calozet Y, Camps K, Capiau L,
Celis H, Coucke F, D’Argent F, De Beeck G, De Meulemeester M, De Praeter K, De
Rouck S, Delcourt A, Delvaux J, Demanet E, Derijcke M, Deruyck C, Devaux J, Dupont
C, Duyse J, Erpicum L, Gilio C, Gillet A, Grosjean J, Heeren J, Henry G, Heyvaert F,
Hollanders G, Hutsebaut A, Janssens P, Lannoy H, Ledoux C, Legros P, Leliaert R,
Martens R, Maury O, Mehuys G, Michaux J, Migeotte A, Mortelmans J, Mulders N,
Parijs P, Peer W, Pieters E, Reynders P, Riet D, Robert P, Stee J, Teheux J, Teuwen J,
Timmermans B, Tshinkulu M, Vantroyen D, Veevaete M, Vercruysse K, Vereecken G,
Vermeersch L, Vernijns J, Verspecht E, Vinck G, Vrancken F, Watte G, Weymans J,
Windmolders S, Ziekenhuis J, Ziekenhuis P, Brazil 327: Albuquerque D, Barbosa E,
Bertolami M, Blacher C, Brasileiro A, Eliaschewitz F, Esteves J, Feitosa G, Filho H,
Filho R, Fonseca F, Forti A, Francischetti E, Franco R, Gomes M, Gross J, Jardim P,
Kohlmann O, Loures-Vale A, Magalhaes M, Maia L, Moriguchi E, Nogueira P, Oigman W,
Repetto G, Saraiva J, Xavier H, Bulgaria 197: Balanescu S, Benov H, Chompalova B,
Donova T, Gocheva N, Goudev A, Grigorov M, Gruev T, Hergeldjieva V, Marchev S,
Mihov A, Pasheva V, Penev A, Popov A, Raev D, Sirakova V, Slavcheva A, Stoikov A,
Stoilov R, Tisheva S, Todorov G, Torbova S, Uzunangelov J, Canada 2020: Achyutna G,
Akhras R, Arun N, Barriere G, Bartlett J, Behiels S, Bell A, Bergeron J, Berlingieri J,
Bhamjee H, Bodok-Nutzati R, Booth W, Boyd C, Brault S, Bruckswaiger D, Bukovy B,
Campbell G, Carlson B, Cha J, Chehayeb R, Cheng W, Chilvers M, Chouinard G,
Chow W, Conter H, Conway J, Craig D, Dattani I, Del Grande R, Dharamshi S,
Dickson M, Dion D, Dowell A, Drexler J, Dube S, Dupont A, Dworkin B, Fields L,
Filteau P, Gardiner E, Gervais B, Gillis G, Girard R, Goldman H, Gorfinkel I, Goulet S,
Greenspoon A, Gritter R, Gupta A, Gupta M, Habib R, Harding R, Hart R, Henein S,
Henry D, Hirsch A, Ho K, Hoag G, Houde D, Howlett E, Ing G, Jadd J, Janes J, Jardine F,
Johnston T, Kanani S, Kazimirski M, Kelly A, Klajner F, Kooy J, Lalani A, Lam S,
Laranjeiro J, Larose D, Leiter L, Leung W, Li J, Lowe D, Luces K, Ma P, MacKinnon R,
Martinho V, Matangi M, McCrossin M, McIsaac J, McMullen W, Mehta P, Meunier M,
Misik K, Ng A, Nigro F, Noronha L, O’Mahony W, Pandey S, Papp E, Patel V , Patrick L,
Peddle C, Pinsky N, Poirier P, Powell C, Price J, Rolfe A, Saliba N, Sawkiw R, Senior R,
Shu D, Smith R, Somani R, Soowamber M, Stakiw K, Talbot P, Taliano J, Tan K,
Teitelbaum I, Threoux P, Tremblay G, Turcotte C, Tytus R, Walsh P, Webb G,
Willoughby P, Woo V, Woodland R, Yee G, Chile 83: Blanco M, Cardenas N,
Dominguez J, Gutierrez M, Jalaf M, Olivares P, Rodriguez B, Saelezer C, Stockins B,
Colombia 345: Ardila W, Aschner P, Botero J, Botero R, Calderon C, Casas L,
Castellanos R, Chaves A, Cure C, Escobar I, Fortich A, Garcia L, Hernandez E, Isaza D,
Jaramillo N, Kattah W, Marin M, Matiz C, Quintero A, Rizcala A, Rodriguez N, Ruiz A,
Urina M, Valenzuela A, Costa Rica 270: Cob-Sanchez A, Gutreiman-Golberg M,
Lainez-Ventosilla A, Ramirez-Zamoraa L, Slon-Hitti C, Vinocour-Fornieri M, Denmark
336: Hansen H, Nordestgaard B, Steffensen R, Stender S, El Salvador 162: Abrego H,
Renderos J, Rivera-Ochoa L, Estonia 85: Eha J, Jaanson E, Kaasik U, Keba E, Maetos E,
Petersen M, Reinmets S, Roostalu U, Vahula V, Veidrik K, Germany 222: Bellmann R,
Hanefeld M, Horacek T, Klein C, Knels R, Koenig W, Laus S, Meibner G, Mondorf C,
Schell E, Schuster H, Sehnert W, Stahl H, Szelazek G, Winkelmann B, Witczak E, Israel
143: Avishay E, Gavish A, Grossman E, Haratz D, Hussein O, Keider S, Levy Y, Shapiro
I, Shveydel E, Wolfovitz E, Yogev R, Zeltser D, Mexico 741: Escarcega J, Galvez G,
Gonzalez J, Guajardo S, Gutierrez-Fajardo P, Ibara M, Leon J, Lozano F, Munoz E, Pina
J, Romero-Zazueta A, Sanchez R, Takahashi H, Villalpando C, Villegas E, Netherlands
987: Agous I, Bak A, Bartels G, Basart D, Cornel J, De Schipper L, Holwerda N, Kose
V, Koster Y, Lok D, Lokhorst B, Mosterd A, Nierop P, Oude Ophuis A, Somer S, Tiebesl
J, Trip M, Van Hessen M, Van Kempen W, Wassenaar M, Norway 204: Andresen M,
Berz A, Bjurstrom M, Bo P, Brunstad O, Daae-Johansen T, Elle S, Fauske J, Fossdal B,
Gjefsen O, Hallaraker A, Haugen J, Helberg S, Holm-Johnsen S, Istad H, Jacobsen T,
Johansen R, Jorstad T, Jorum I, Kjorlaug K, Kontny F, Langaker K, Larsen B, Lonning
S, Loraas A, Mansilla-Tinoco R, Medhus R, Meyer I, Nasrala S, Ofjord E, Ose L, Palmas
J, Risberg K, Sandberg A, Sirnes P, Skjegstad E, Skjelvan G, Solnor L, Storm-Larsen A,
Tandberg A, Tomala T, Torkelsen A, Ursin A, Valnes K, Walaas K, Panama 202: Binns
R, Delgado A, Lombana B, Noriega L, Trujillo R, Poland 804: Artemiuk E, Asankowicz-
Bargiel B, Banas I, Baranska E, Baranski M, Bijata-Bronisz R, Sikorska A, Blasszczyk B,
Bolanowski J, Brokl-Stolarczyk B, Brzecki K, Buczkowski K, Chmielewski T, Chojnowska-
Jezierska J, Chwist-Nowak A, Cygan W, Czajkowska-Kaczmarek E, Dargiewicz A,
Dluzniewski M, Dudka C, Fares I, Flasinska J, Gadzinski W, Gaszczyk G, Golebiowski G,
Gozdur W, Grudzien K, Kalamarz J, Kalinowska A, Kornacewicz-Jach Z, Korol M,
Korycka W, Kostka T, Kostrzewska A, Kot A, Kowalczyk-Kram M, Kowalska-Werbowy B,
Krupinska G, Lotocka E, Luberda-Heynar Z, Lukas W, Lysek R, Machyna-Dybala A,
Mlynarczyk-Jeremicz K, Mocarska-Gorna B, Niedbal-Yahfouf I, Pasternak D, Potakowska I,
Ramian U, Roleder M, Rosinska-Migda J, Sidorowicz-Bialynicka A, Skierkowska J,
Skorinko I, Slaboszewska J, Sleziak-Barglik K, Sobieska E, Stachlewski P, Superson-Byra E,
Tissler-Nahorska G, Turbak R, Uzunow A, Wasowicz D, Wodniecki J, Wojnowski L,
Wrzol A, Zdrojewska J, Zurakowska-Krzywonos A, Zurowska-Gebala M, Romania 32:
Ablachim T, Abobului M, Bobescu E, Bojinca M, Cristea M, Gaita D, Stoicovici R, Tataru R,
Tudose A, Russia 273: Ardashev V, Arutyunov G, Azarin O, Barbarash O, Bondarev S,
Borisov M, Boyarkin M, Burova N, Chazova I, Dovgalevsky P, Duplyakov D, Egorova L,
Goloshchekin B, Gratsianskiy N, Ivleva A, Karpov R, Karpov Y, Khokhlov A, Khokhlov R,
Khrustalev O, Konyakhin A, Kostenko V, Libov I, Lukyanov Y, Mezentseva N, Panov A,
Repin M, Shabalin A, Shalaev S, Shilkina N, Shulman V, Sidorenko B, Smolenskaya O,
Starodubtsev A, Talibov O, Titkov Y, Tsyba L, Uspenskil Y, Vishnevsky A, Yarokhno N,
South Africa 2497: Ahmed S, Ashtiker H, Bester A, Bhorat Q, Biermann E, Boyd W, Burgess L,
Dindar F, Dulabh R, Engelbrecht I, Erasmus E, Fouche L, Furman S, Govind U, Herbst
L, Jacovides A, Kahanovitz C, Kruger C, Lakha D, Lombaard J, MacLeod A, Makan H,
Manuel E, McDonald M, Mitha E, Mitha I, Moola S, Nell H, Nieuwoudt G, Olivier P,
Padayachee T, Pillai P, Pillay S, Ranjith N, Reyneke S, Routier R, Sandell P, Sebastian P,
Skriker M, Smit J, van Rensburg D, van Zyl L, Vawda Z, Wellman H, Switzerland 15:
Stahl M, United Kindom 2873: Adbulhakim E, Angus M, Balmer F, Balmer J, Barrat R,
Blair D, Blyth A, Brodie R, Brydie D, Campbell C, Campbell I, Church M, Clark C,
Clements R, Donnachie H, Fitpatrick P, Godley C, Hill J, Jarvie F, Kieran W, Langridge S,
Leslie R, Liddell A, MacKenzie J, MacKintosh C, Mair R, Marshall G, Martin R,
McCann C, McKibbin C, McLachlan B, McLean F, Murray S, Norris A, Pawa R, Pexton
N, Ramage A, Reid S, Robertson A, Rourke E, Sarmiento R, Shaw H, Shaw R, Sheil L,
Spence G, Stewart E, Thomas H, Thomson J, Thomson W, Travers J, Ward R, Williams
L, Wooff D, Young W, Uruguay 14: Belzarena C, Huarte A, Kuster F, Lluberas R,
Speranza-Sanchez M, United States 4021: Abarikwu C, Abate L, Abbott R, Ackley C,
Adams G, Adkins S, Albakri E, Albarracin C, Allison J, Alvarado O, Alwine L, Amin K,
Amin M, Anderson J, Anderson M, Anderson W, Andrawis N, Andrews C, Angles L,
Aquino N, Ariani M, Armstrong C, Aronoff S, Arora N, Atri P, Baker J, Baker K, Balli
E, Banish D, Bardenheier J, Barnett G, Bartkowiak A, Basista M, Beliveau W, Bell G,
Benchimol G, Bennett B, Bennett N, Bermudez Y, Bernstein J, Berroya A, Bhargava M,
Biaggioni I, Bimson S, Bittar N, Bleser S, Blumberg M, Bobson C, Boeren J, Bogan R,
Boling E, Booras C, Borge A, Brady J, Brandon D, Bredlau C, Brideau D, Brobyn T,
Brodowski M, Broker R, Broussard C, Brown C, Browning D, Brusco O, Bryant J,
Buchanan P, Bueso G, Burgess G, Burke B, Buynak R, Byrd L, Camilo-Vazquez E,
Campbell J, Cannon L, Capo J, Carmouche D, Castaldo R, Castilleja J, Caudill T, Caulin-
Glaser T, Champlin J, Chardon-Feliciano D, Cheng T, Cherlin R, Cheung D, Chodock A,
Christensen J, Christian D, Christiansen L, Ciemiega R, Clark J, Coble S, Cohen K,
Colan D, Cole F, Cole R, Colleran K, Collins G, Conard S, Cook J, Cooperman M,
Cooze D, Copeland T, Corder C, Courtney D, Cox W, Crump W, Cruz L, Cuellar J,
Cunningham T, Daboul N, Dailey R, Dallas A, Dansinger M, Dao L, Darwin C, Dauber
I, Davidson M, Davis P, Degarmo R, Degoma R, Dempsey M, Denny D, Denyer G,
Desai V, Despot J, Dewan M, Dickert J, Diederich C, Doben S, Dobratz D, Douglas B,
Drehobl M, Dresner J, Dreyfus J, Drummond W, Dunbar W, Dunlap J, Dunmyer S,
Eaton C, Ecker A, Edris M, Egbujiobi L, Elkind A, Ellis J, Ellison H, Engeron E, Erdy G,
Ervin W, Eshowsky S, Estock D, Fang C, Fanning J, Feinberg B, Feld L, Fenton I,
Fernandez E, Ferrera R, Fiacco P, Fierer R, Finneran M, Fintel D, Fischer M, Flippo G,
Flores A, Folkerth S, Forbes R, Fowler R, Francis P, Franco M, Frank A, Fraser N,
Fuchs R, Gabriel J, Gaddam S, Gaffney M, Gamponia M, Gandhi D, Ganzman H, Gaona
R, Gaona R Jr, Garibian G, Garofalo J,, Gatewood R, Gazda S, Geiger R, Geller M,
Germino W, Gibbs R, Gifford C, Gilhooley N, Gill S, Gillespie E, Godwin D, Goldberg
M, Goldberg R, Goldstein M, Gonzalez-Ortiz E, Goodman D, Gordon G, Gordon M,
Goswami A, Gottlieb D, Gottschlich G, Graham D, Gray J, Gray W, Green S, Greenberg
R, Greenspan M, Greenwald M, Grover D, Gupta, R, Gupta-Bala S, Guthrie R, Gutmann
J, Gvora T, Habib G, Hack T, Haidar A, Hamdy O, Hansen M, Hanshaw C, Hargrove J,
Harris H, Harris H, Harrison B, Hart T, Heacock J, Head D, Headley D, Henderson D,
Herman L, Herrera C, Hershberger V, Hershon K, Heym H, Hill G, Hippert R, Hirsch A,
Hnatiuk G, Hoekstra J, Holt W, Homan J, Honsinger R, Howard J, Howard V, Howard
W, Huling R, Imburgia M, Isajiw G, Ison R, Iverson W, Jacks R, Jackson B, Jackson K,
Jacobs J, Jacobson E, James A, Jayanty V, Johary A, Johnson G, Jones P, Jones T, Joseph
J, Julien C, Kahn Z, Kalvaria I, Kang J, Kaplan I, Karns R, Kashi K, Kaster S, Kaufman
A, Kawley F, Keller R, Kenton D, Kerlin J, Kern J, Kerwin E, Kerzner B, Ketchum J,
Khan J, Khan S, Khawar M, Khera A, Kinstrey T, Klein B, Klein E, Klein S, Klein T,
Kleinsteuber K, Klementowicz P, Knopp R, Knutson T, Koch S, Kramer M, Krause R,
Krisciunas V, Krueger C, Kruszewski D, Kumar R, Kunst E, Kuo D, Kuritsky L,
Kushner P, Kutner M, Kwiterovich P, Kwong S, Lanese J, Lang B, Lary J, Lasalle J,
Lasater S, Lasser N, Laughlin D, Lawless J, Lawlor D, Ledbetter J, Ledesma G, Lee D,
Lemanski P, Levinson G, Levinson L, Lewis D, Lewis L, Lewis S, Linden D, Loh I,
Look M, Lopez D, Loskovitz L, Lubin B, Lucas M, MacAdams M, Madden B, Magee P,
Maggiacomo F, Magier D, Magnuson S, Mahaffey R, Makowski D, Maletz L, Mally A,
Maloney R, Mancha V, Manolukas P, Marple R, Martin R, Masri A, Masri B, Mattingly
G, Mayer N, McCain A, McCall Bundy J, Mccartney M, Mcclain D, McConn M,
Mccullum K, Mcdavid R, Mcgettigan J, McIvor M, Mcneff J, Mendolla M, Mercado A,
Mersey J, Milam J, Milko T, Miller M, Miller R, Miller S, Mobley D, Modi T, Modiano
M, Mollen M, Montgomery R, Moran J, Morelli J, Morin D, Moskow H, Moursi M,
Mueller N, Mullins M, Myers E, Nadar V, Naiser J, Nash S, Natarajan S, Neft M,
Neuman D, Nevins B, Newman J, Newman R, Newman S, Nolen T, Nwasuruba C,
Oberoi M, Odom A, Ong Y, Oppy J, Owen S, Pampe E, Pangtay D, Parker R, Patel B,
Patel J, Patel M, Patel R, Paul A, Pearlstein R, Penepent P, Peniston J, Perlman M,
Persson D, Peters P, Peterson G, Peterson J, Pettyjohn F, Phillips A, Phillips D, Piel M,
Pillai T, Pi-Sunyer F, Pollack A, Pond M, Pongonis J, Porras C, Portnoy E, Potos W,
Powers J, Prasad J, Pritchett K, Pudi K, Pullman J, Purdy A, Quinones Y, Raad G,
Radbill M, Radin D, Rai K, Raikhel M, Raine C, Ramanujan R, Ramirez G, Ramos-
Santana Z, Rapo S, Ravin S, Rawtani P, Reeves R, Reeves W, Reiter W, Rendell M,
Resnick H, Reynolds W, Rhudy J, Rice L, Rictor K, Ringrose R, Riser J, Rizvi M, Rizzo
W, Robinson J, Robison W, Rogers W, Rohlf J, Rosen R, Ross, E, Roth E, Rovner S,
Rucki P, Runde M, Ryan W, Rybicki J, Saleem T, Salvato P, Santram D, Scharf B,
Schear M, Schectman G, Schmidt J, Schneider A, Schneider P, Schneider R,
Schoenfelder S, Schussheim A, Schwartz R, Schwartz S, Schwarze M, Scott C, Segal S,
Settipane R, Shah M, Shamim T, Shanes J, Shapero P, Shapiro J, Shealy N, Shepard M,
Shepherd A, Sheta M, Shrivastava R, Shusman R, Siddiqi M, Sidney A, Silvers D,
Simek C, Simpson C, Sinatra L, Singh S, Singson D, Slabic S, Smith D, Smith K, Smith
S, Smith T, Snell P, Specter J, Speer J, Spees R, Sperling M, Spuhler W, Staab P,
Stafford J, Stanton D, Stein E, Stern S, Stocks T, Stone A, Strader W, Strout C, Strzinek
R, Subich D, Suen J, Sugimoto D, Sulman S, Suresh D, Sweeney G, Szatkowski A, Szeto
J, Szewczak S, Szulawski I, Taber L, Taghizadeh B, Tague R, Tambunan D, Tannoury G,
Tavarez Valle J, Thieneman A, Thigpen D, Thompson P, Tidman R, Tilton G, Tokatlian
E, Topkis R, Torelli M, Tortorice F, Toth P, Touger M, Treat S, Trevino M, Trupin S,
Turner A, Turner M, Tweel C, Ugarte J, Ulmer E, Urbach D, Vacker M, Vallecillo J, van
de Beek M, Vargas L, Vazquez Tanus J, Verma, A, Vijayaraghavan K, Wade P, Wade T,
Wagner S, Wahle J, Walker J, Walker M, Weinstein R, Weisbrot A, Weiss R, West P,
White A, Wickemeyer W, Wieskopf B, Wiggins M, Williams H, Wilson M, Wiseman J,
Yataco A, Yates S, Zamarra J, Zamora B, Zawada E, Zemel L, Zigrang W, Zusman R,
Venezuela 209: Aguiton M, Arroyo-Parejo M, Beaujon Sierralta J, Carrizales de Marlin
Y, Colan Parraga J, Fernandez C, Fuenmayor N, Giesen G, Gonzalez Gomez C, Guaipo
A, Herrera Rivera C, Lopez de Montoreano N, Lopez Nouel R, Marturet L, Marulanda
M, Mata L, Morr I, Nass A, Palmucci G, Ponte C, Rivas I, de Roa E, Figarella Salazar G,
Sanchez F, Sirit U, Viloria A.

JUPITER is a gas giant

An excellent article by André Picard in today’s Globe and Mail, the only story on JUPITER I have seen in the lay press that reveals the massive fraud behind the reporting of this “study”.

JUPITER is aptly named. It’s gigantic. Probably the largest, most expensive drug trial in history. When one looks below the surface of the publication in the NEJM, the results are about as exciting as the Jovian composition. A lot of gas. I would conservatively estimate that this “study” cost at least $500 million. But if you are AstraZeneca and stand to sell $many billions worth of Crestor because of this paper that’s small change. And junk food addicts, who comprise most of the subjects of JUPITER have one more excuse, however deceptive, to continue their self-destructive habits.

Here is my opinion posted in the NEJM blog on the paper.

A more detailed analysis of the marketing driven deception and lack of professionalism in the paper by Sandy Szwarc.

Another perspective by John McDougall similar to mine on the big lie behind the claim that many “healthy” people need Crestor.

For an insightful analysis of the obfuscation in the reporting of mortality data in JUPITER see here.

Another devastating critique of Jupiter by the Michel de Lorgeril who many years ago proved that simple diet changes could dramatically prevent heart attacks and prolong life after a heart attack with NO statins.

When all of these criticisms are considered it turns out that JUPITER is nothing more than a thinly disguised  infomercial for Crestor and should never have been published in a presumably high quality journal like the NEJM. But in being able to make this paper freely available on the web (and not wait 6 months like other papers) the NEJM must have received a large payment from AstraZeneca.

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Lead “investigators” of JUPITER

Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., Robert J. Glynn, Sc.D., for the JUPITER Study Group

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When it comes to statins, don’t believe the hype

November 20, 2008
The Globe and Mail
André Picard”Cholesterol drug causes risk of heart attack to plummet” – Fox News.

“Cholesterol-fighting drugs show wider benefit” – The New York Times.

“Cholesterol drug cuts heart risk in healthy patients” – The Wall Street Journal.

The New York Times article summarized the exciting news in a front-page story saying that “millions more people could benefit from taking the cholesterol-lowering drugs known as statins.”

That’s big medical/business news, because statins are already the bestselling drugs in the world, with sales in excess of $20-billion (U.S.).

Quoting some of the world’s top heart researchers, media reports touted the importance of a blood test for C-reactive protein. That’s because those benefiting from statins had high levels of CRP (a marker for inflammation) rather than high levels of LDL cholesterol, which is usually the criterion for statin prescription.

The news stories were based on research published last week in the prestigious New England Journal of Medicine and presented, with much fanfare, at the annual convention of the American Heart Association.

Like much reporting on medical research (and drug research in particular), however, there is more (or, more accurately, less) to these stories than meets the eye.

The principal finding in this study was that participants who took a statin pill recorded a 50-per-cent reduction in the risk of heart attack, stroke, surgery and death compared with those who took a placebo (a sugar pill).

Who wouldn’t be wowed by those numbers? Who wouldn’t want that miracle drug?

But the benefits are relative risk reductions.

When you look at the raw data in the study, they reveal that 0.9 per cent of statin users had cardiovascular problems. By comparison, 1.8 per cent of those taking a placebo had heart problems.

There were 17,802 participants in the study, yet there were only 83 cardiac events among statin users, compared with 157 in the placebo group. That’s 50 per cent fewer.

Are those really “dramatic” findings? Do statins really make heart attack risk “plummet”?

According to a cautionary editorial in the New England Journal of Medicine (which received virtually no mention in news reports), 120 people in this study needed to be treated with a statin for two years to see a benefit in one person.

That’s a lot of people taking a pricey drug ($3 Canadian a day) for no benefit – not to mention that there are risks.

While researchers (and journalists who report on studies) love to highlight benefits of drugs, they too often gloss over risks.

Like all drugs, statins have side effects. The drug used in the study, rosuvastatin (brand name Crestor), has been associated with muscle deterioration and kidney problems.

In the study, those taking statins had a higher risk of developing Type 2 diabetes – 3 per cent compared with 2.4 per cent of those taking a placebo. That’s a 25 per cent higher relative risk among people with very little heart disease to begin with.

As noted earlier, researchers (and news stories) suggested that, based on the findings, the number of patients taking statins could and should expand dramatically.

But is that really what the research tells us, even in its most optimistic interpretation?

The study involved exclusively men older than 50 and women older than 60 who did not have high cholesterol or histories of heart disease or inflammatory illness. All the people in the study needed to have low cholesterol and high CRP.

Initially, researchers recruited 90,000 people in those age groups, but more than 80 per cent of them were deemed ineligible. This is a very select population.

To say, by extrapolation, that these “dramatic” (read: modest) benefits apply to the general population is erroneous.

Similarly, while it is true that about half of all heart attacks and strokes occur in people whose cholesterol is not considered high, does that mean everyone should get a blood test to measure levels of C-reactive protein? Hardly.

Yes, there is more heart disease among people with high levels of CRP, but the jury is still out on what this means.

Some scientists believe that because CRP – secreted in response to inflammation – is present in plaque, it increases the risk that the plaque will burst, leading to blood clots that cause heart attacks. But other researchers think that CRP levels are, at best, a telltale sign of heart disease, a bit like grey hairs are a sign of aging – not its cause.

The CRP test is expensive at almost $50. And it’s worth noting that one of the principal authors of the new research holds the patent on the test and makes money every time it is used.

When you cut through all the hype and the self-interest, what we know is this: Statins reduce levels of [LDL] cholesterol. This is beneficial to people who have had a heart attack or other serious heart problems.

But for otherwise healthy people, high CRP levels or not, the potential benefits of taking statins are marginal, and the risks are not insignificant.

Hardly the stuff of dramatic newspaper headlines.

What typical JUPITER subjects would look like. These are "apparently healthy" people?

Nowhere in the JUPITER paper will you see it mentioned that CRP can be markedly reduced with cost-free lifestyle change alone, no statins, as shown in this paper in the Journal of Applied Physiology in 20006, results of which are summarized below. The subjects in the JAP paper were just the same as in the JUPITER study, obese people, many with metabolic syndrome but the authors did not call them “apparently healthy”. They had nothing to sell.

Prudent diet staves off heart woes (The Gazette, 21 Oct 2008, Page A4)

Not a surprising finding, Dr. Yusuf. Fifteen years ago Dean Ornish proved that atherosclerosis, the underlying cause of heart attacks, could be reversed with a version of the prudent diet.  So why isn`t everyone doing this? Maybe because the cholesterol myth promoted by drug dealers and doctors on their payrolls convinced the population that all they had to do was take a pill to lower blood cholesterol and they could eat anything. Curiously, there is no mention of cholesterol in the story. Close reading of the paper published in Circulation reveals that there was no correlation between the diet and blood cholesterol, “bad” of “good”. Diet has a powerful effect on atherosclerosis independent of blood cholesterol. Probably something about the prudent diet reduces modification of LDL, so called “bad” cholesterol, in the arterial wall. Another body blow to the cholesterol myth which is slowly dying. Even Pfizer which has spend many $billions promoting the myth has given up on it.

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SHARON KIRKEY CANWEST NEWS SERVICE
The Gazette
21 Oct 2008

Hold the fries, samosas or fried won tons: People who eat diets high in fried foods and meat are 35 per cent more likely than ?prudent? eaters to suffer acute heart attacks, a global study led by Canadian researchers shows. And in a surprising…read more…

Tech Tags: The Gazette newspaper Health Matters

Heart Attack at Age 19

Cherepanov is not the first young Russian athlete to die of atherosclerosis. Remember Sergei Grinkov? The Russian diet is highly atherogenic and Russia has one of the highest rates of death from coronary artery disease.

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In 1994 Gordeeva & Grinkov returned to Olympic competition and captured their second gold medal at the 1994 Winter Olympics in Lillehammer, Oppland, Norway. After these Olympics, they returned once again to professional skating and took up residence in Simsbury, Connecticut. During the 1994-95 season, they toured, yet again, with Stars on Ice, this time as headliners. However, tragedy struck in November 1995, when Sergei Grinkov collapsed and died from a massive heart attack in Lake Placid, New York, while he and Ekaterina were practicing for their upcoming performance in the 1995-1996 Stars on Ice tour. Doctors found that Sergei had severely clogged coronary arteries (to the point where his arterial opening was reportedly the size of a pinhole), which caused the heart attack.

“In spite of the autopsy findings, he never sought medical attention for a cardiac problem,” said Pascal Goldschmidt associate professor of cardiology at Johns Hopkins. “His risk for premature coronary artery disease was very low; he was not a smoker, did not use drugs or medications, did not have high blood pressure or diabetes, had normal cholesterol and lipid levels and he trained several hours a day.”

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NO AMBULANCE
BY MASON LEVINSON Bloomberg News, with files from Gennady Fyodorov and Natalia Sokhareva, Reuters
National Post
15 Oct 2008

Russian officials opened a probe into the death of New York Rangers? first-round pick Alexei Cherepanov, who collapsed on the bench during a Continental Hockey League game in Russia on Monday. Moscow regional investigator Yulia Zhukova said officials…read more…

Tech Tags: National Post newspaper Sports

Effectively treating atherosclerosis without angioplasty or bypass

Below is a example of the issues involved in treating chronic coronary atherosclerosis presented by an intelligent patient who asked questions about treatment and did not accept the mainstream opinion without good evidence.

The vast majority of patients with chronic coronary artery atherosclerosis can be treated as the patient described here. Most cardiologists still believe the profitable myth that heart attacks can be prevented by “treating” those blockages seen on a coronary angiogram. We now have good evidence that such blockages are composed of older, harder plaques that are less likely to rupture and cause a sudden total blockage and a heart attack. Angioplasty, stent or not, and coronary bypass are PALLIATIVE procedures indicated only for intractable symptoms related to decreased coronary blood flow reserve.

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From ProCor

From the patient’s perspective: Effectively treating heart disease through diet, exercise, lifestyle and medication

In the late 1960s, Professor G. S. H. Lock was engaged in the development of the artificial heart to address cardiac conditions for which other alternatives were not available. Forty years later he writes, “Today it is difficult to argue that technological intervention on such a scale is really necessary on a routine basis. Even intervention through angioplasty and the insertion of a stent may offer little more than temporary relief.”

In this article, adapted from a longer feature in The Lown Forum, Professor Lock shares his experiences as a cardiac patient and his observations on the use of medical technology in cardiovascular care. The Lown Forum is a publication of the Lown Cardiovascular Research Foundation; ProCor is one of its programs.

Vikas Saini
President, Lown Cardiovascular Research Foundation
 
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From the patient’s perspective: Effectively treating heart disease through diet, exercise, lifestyle and medication

G.S.H. Lock, Professor Emeritus and former Dean of Interdisciplinary Studies, University of Alberta, Edmonton, Alberta, Canada

My story begins, as it often does, with the onset of mysterious chest pains. My family physician immediately diagnosed it as angina, meriting further investigation. After numerous tests on treadmills and in machines whose operations are still a mystery to me, I was confirmed as a high-risk patient with a plumbing problem, usually described as coronary arterial occlusion. An angiogram was recommended and scheduled within two weeks. However, this seemingly routine procedure created a special problem for me because three of my colleagues had failed to recover from that very procedure. With apprehension, I listened to the consulting physician explain that the risk of complication was minimal (about 1%). I asked if there was an alternative. I shall never forget his answer: “Death.”

Needless to say, I was not reassured by this response from a very able doctor who was obviously bound by prescribed procedure. Even though he was careful enough to prescribe appropriate medication while I waited for the angiogram procedure, I sought a second opinion, at another hospital. This proved to be an equal waste of time. The physician simply described the use of angiography as a “no brainer” because he viewed it as the natural prelude to intervention. No other possibility was even considered.

These experiences led me to conduct my own extensive research on heart disease, its diagnosis, and treatment. The majority of cardiologists seem to favor intervention, with all of the technology that accompanies, if not drives, it. I, however, could not support such an approach except in emergencies or when surgery was clearly the only means by which a patient’s life could be improved if not saved. Through the Lown Cardiovascular Center I was able to confirm that a healthy minority of cardiologists are not interventionists, but believe instead that in the majority of cases, heart disease may be treated more effectively using medical therapy with its four components: diet, exercise, lifestyle, and medication.

At first glance, I thought that each of these would prove to be distasteful – something that would destroy the quality of life – but I found instead the very opposite.

Luckily for me, my wife is an excellent cook – dare I say chef? – and has developed the standard Mediterranean diet into such a variety of dishes that I eat better now than I did two years ago. This alone took my cholesterol level down well below the established safe limit.

Exercise, too, has improved my quality of life. My cardiologist at the Lown Center, Dr. Vinch, is himself and athlete and he reminded me that the heart is a muscle that needs to be nourished and exercised like any other muscle. Under his guidance, I began various walking exercises. At first, using a nitroglycerine spray to decrease the resistance of the peripheral vascular system, I took my daily walks in the river valley where I live. Gradually, the walks became longer and steeper. Today, I can briskly walk up and out of the river valley and then jog up 12 flights of stairs without any angina, and without using the nitroglycerine. 

Clinical Encounter 
Date Posted: 9 April 2008

Free Online CME – Drug Dealers’ Propaganda

Here is a classical example of “free” online CME (Continuing Medical Education) funded by drug dealers and given legitimacy by association with presumably ethical institutions, like “prestigious educational institutes”. Doctors have to accumulate CME credits to maintain their licenses, so they are obliged to look at this propaganda. It seems doctors don’t make enough to pay for their own continuing education and have to depend upon the drug dealers to keep them informed. Shed a tear.

How much is McGill paid to allow it’s logo on this propaganda? McGill is a publicly chartered and funded institution. One should be able to find out but good luck.

Both members of the “Planning Committee” are compromised by financial connection to one or more drug dealers.

David Fitchett is particularly notorious for multiple connection to drug dealers.

But Dr. Fitchett is labeled an “expert”. What has Dr. Fitchett ever done, any more than any other graduate of a medical school, to be considered and expert? I have no idea.

Dr. David Fitchett, Expert

Watch a medical terrorist in action. Take that “powerful” statin to reach “target”, get that muscle pain. If you don’t you will die.

We are advised that “…it is unlikely that lipid targets can be achieved in the absence of pharmacological therapy” and we are given references for these targets. Who sets these targets, anyway? You haven’t guessed by now? In Canada it’s the “Working Group“, all of whom have financial connections with multiple drug dealers and who are chosen to be the conduits of divine revelation by groups like the Canadian Cardiovascular Society that get most of its funding from drug dealers.

And those “resources”? Again, paid for by drug dealers.

So, what appears on the surface to be a scientifically legitimate educational exercise turns out to be propaganda funded by drug dealers at multiple levels. Drug dealers pay doctors and their organizations to promote “targets” for blood  cholesterol, pay “prestigious” institutions for their approval, pay for the web sites, like mdbriefcase, for CME to promote measurement of blood cholesterol and drugs to lower it and doctors must read it to keep their qualifications. What a wonderful marketing machine! And it’s all legal. But what happened to medical professionalism?

Medical Devices – No Controlled Trials

“I’m not allowed to prescribe one pill unless it has gone through years of trials,” said Dr. Colin Rose, a Montreal cardiologist. “Why can they license these [devices] — which can be just as dangerous — with no controlled trials? What is the difference?

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MEDICAL IMPLANTS
BY TOM BLACKWELL
National Post
24 Jul 2008

Late in the 1990s, Health Canada licensed a new artificial lens, the latest in an innovative generation of implants for treating cataracts. Made from a foldable material, it could be inserted in the eye with a smaller incision than usual and less-invasive surgery. It did not matter, under the department’s rules, that the device had been tested on relatively few people before being approved.

As thousands of the newly licensed lenses were installed worldwide, however, doctors started noticing a serious defect with many of the implants: they were turning opaque inside patients, and in some cases had to be removed with a much more complex operation through the individual’s temple.

“ The ophthalmologists were petrified,” said Dr. Pierre Blais, a former Health Canada official who now does consulting work on medical devices for insurance companies. “They said, ‘We can’t trust these [regulatory] agencies. We have to do our own trials.’ ”

But the eye implant case was no exception. Health Canada routinely approves surgical devices after limited — or no — study on humans, far less evidence than is required for the certification of prescription drugs. And now some experts are raising serious concerns about the process.

The number of devices being inserted into Canadians’ bodies is soaring, and there is no doubt many work wonders: saving patients’ eyesight, relieving debilitating joint pain or preventing lethal heart irregularities.

In a recent article, however, several prominent obstetricians and gynecologists accuse Health Canada of failing in its ethical duty to protect patients, and call on the regulator to impose the same kind of strict approval criteria for devices as for drugs.

“Most people assume that … any surgical device licensed in Canada must be safe for human use,” notes the paper, co-authored by the president of the Society of Obstetricians and Gynaecologists of Canada. “As things currently stand, this assumption is not justified.” The paper, published in the society’s scientific journal, cites Health Canada’s approval in 2006 of a new surgical implant to combat female incontinence. At the time, the device had never been tested on a single person. Within a year, though, the freshly approved “vaginal tape” had been permanently installed in more than 1,000 Canadian women.

Individual case reports have so far been generally positive, but a clinical trial proving they are safe and effective has yet to take place. Concerns reach beyond gynecology. A trial published last year found that angioplasty — a widely hailed procedure that uses a tiny balloon to clear harmful plaque from clogged arteries — did no better than much cheaper, intensive drug treatment and exercise to treat stable heart patients. The device had been used for years on about 40,000 Canadians annually, most of them stable.

“I’m not allowed to prescribe one pill unless it has gone through years of trials,” said Dr. Colin Rose, a Montreal cardiologist. “Why can they license these [devices] — which can be just as dangerous — with no controlled trials? What is the difference?”

Other doctors and the industry, though, argue that requiring devices to be extensively studied before approval would be impractical and hamper important innovation. With changes and improvements constantly being introduced, devices have a much shorter shelf life than drugs, meaning companies could not recoup the tremendous investment needed to conduct pricey clinical trials, they say.

“It would be great to have a perfect system that makes sure we understand what the benefits and risks are of everything,” said Dr. David Urbach, a Toronto surgeon who has studied how new surgical techniques are adopted. “But if it took 10 or 15 years to bring a device to market, you’d never use any devices, because they’d be obsolete. We still use drugs, antibiotics, developed 50, 60 years ago. We don’t use devices from even 10 years ago.”

Paul Duschene, a Health Canada spokesman, said the department submits devices to a “robust” approval process, including demands for information showing they are safe and effective. But devices do not need to be vetted the same way drugs do because “the hazards and risks posed to the patient are much different with a medical device,” he said.

Health Canada divides devices into four classes, depending on how much risk they pose to patients. The higher the class, the more evidence is required of a product’s safety and efficacy. Those considered to be incremental modifications of earlier products require less proof.

Class three — which includes gynecological implants such as the vaginal tape, and artificial hip replacements — and class four, including pacemakers and other heart devices, are the most controversial. The vaginal tape was approved based on lab tests and studies on animals, said the paper by the gynecology group.

Another, similar tape approved with no human studies a few years earlier caused considerable problems, frequently eroding inside bodies and triggering infection, said Dr. Sue Ross, a University of Calgary scientist and one of the paper’s authors.

Similar problems occurred with a sling used to reconstruct the uterine cavity in women who had had hysterectomies. The device was meant to prevent collapse of the cavity, but the mesh straps at the core of it would often deteriorate after a couple of years, causing abscesses and other problems, Dr. Blais said. He said the foldable lens — one version of a concept that has generally proven successful — was likely implanted in about 1,000 Canadians, many of them in Alberta, before being recalled.

Then there were heart valves coated with silver, an innovation meant to avoid infection but not tested widely in patients before being licensed in about 1997. As the device was widely distributed, doctors discovered the silver coating sometimes impeded proper melding of the valve with natural tissue, leading to leaks that may have killed some patients, Dr. Blais said. They were later recalled and are now the subject of class-action lawsuits.

In contrast to devices, drugs are regulated in a separate system that requires them to be studied on hundreds of people in a series of clinical trials, which compare the new product against a control group of patients taking a placebo or other treatment.

But Dr. Martin McKneally, a retired surgeon and bio-ethicist at the University of Toronto, argues that clinical trials cannot be carried out for devices when they are first introduced, since the products’ impact differs depending on how it is used by individual doctors, and techniques are honed over time. He believes the key is to adequately inform patients that the implant or other device they are about to receive is novel and has been tested on only a handful of other people.

“You have to learn in patients and keep modifying as you go along,” Dr. McKneally said. “The fact we have such excellent devices is a credit … in part to the patients.”

Even Dr. Blais, once fired and later reinstated over his outspoken comments while at Health Canada, said it may be unrealistic to expect the government to demand extensive clinical trials be done on surgical devices, except those with the highest risk.

It would be more practical for the regulator to simply be up front about the limited vetting that devices undergo before being licensed, and let patients decide if they will accept the risk, he said.

As it stands, Health Canada’s approval of devices “is a licence to test out an idea on somebody else, if possible at government cost,” Dr. Blais said. “What is happening now is we are becoming a nation of uninformed and unremunerated laboratory rats.”