Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘hypertension’

Yves Bolduc – Minister of Health and Drug Salesman

Posted by Colin Rose on April 27, 2009

On learning that Quebec spends much more per capita on drugs than the Canadian average, Yves Bolduc, Quebec’s Minister of Health and Social Services, proclaimed that he wanted everyone to know that this was GOOD NEWS and that he was happy to see that Quebec was ahead of the other provinces. He added that in Quebec people take the drugs they need for their diseases while in the other provinces they don’t take the drugs they need and as a result their high blood pressure and cholesterol problem aren’t treated. He also thinks that spending more on drugs is economic because more drugs mean less is spent in other treatments.

Lets examine the Minister’s logic.

If Quebec is ahead of other provinces, in what respect is it ahead? Quebec has the same life expectancy as Ontario but less than British Columbia who spend much less on drugs. Nova Scotia which spends the most on drugs has one of the lowest life expectancies in Canada. So, there is no correlation between drug consumption and the best measure of overall health, life expectancy.

statcan-lifeexpectancyBolduc says that drugs are needed to treat high blood pressure and cholesterol. Not true. Lifestyle change is far more efficient and cheaper than drugs for treating these “diseases” that are in most cases just symptoms of self-destructive lifestyles. He wouldn’t dare say that all weaned citizens of Quebec should follow a low-fat Mediterranean type diet, eat no junk food and have a waist circumference less than half their height before even considering drugs for lifestyle diseases, like hypertension, diabetes and atherosclerosis. Political disaster. If he did so, the highways of Quebec would be instantly blockaded by pig and dairy farmers. All fast food franchise owners, restaurant owners, junk food producers, their employees and their families would never vote Liberal.

There is not  a shred of evidence that spending more on drugs for the diseases of lifestyle to which he refers translates into less spending on other treatment for these diseases.

So why does the Minister like more drug sales in Quebec and everywhere else? Maybe it’s because drug marketing is the largest industry on the west half of the island of Montreal where there are innumerable drug marketing agencies employing thousands of people funded by profits from Big Pharma. If you run a gigantic bureaucracy like the Ministry of Health and Social Services you need a lot of money and all that tax revenue from drug profits helps your Ministry to get bigger and bigger and gives you more power. So buying more drugs is a form of hidden taxation with no significant benefits in most cases. The Minister wouldn’t dare say that most of the expensive drugs are unnecessary and lifestyle change is essential. He would be reducing his own power and making a lot of voters on the West Island, a stronghold of Liberal power, very unhappy.

ledevoir-pic-bolduc-quote1

Posted in cholesterol, death, drugs, statins | Tagged: , , , , | Leave a Comment »

Disastrous Epidemic of Type 2 Diabetes in Children

Posted by Colin Rose on November 7, 2008

Many more children on medication, study says

‘Surprising’ rise targets diabetes, other obesity-related diseases

November 3, 2008

Baltimore Sun

Hundreds of thousands more children are taking medications for chronic diseases, with a huge spike over a four-year period in the number given drugs to treat conditions once seen primarily in adults and now linked to what has become an epidemic of childhood obesity.

In a study appearing today in the journal Pediatrics, researchers saw surges in the number of U.S. children taking prescription medicines for diabetes and asthma, with smaller increases in those taking drugs for high blood pressure or high cholesterol. All of those conditions, to varying degrees, have been associated with obesity.

Though doctors have been seeing the trend in their practices, “the rate of rise is what’s surprising,” said Dr. Donna R. Halloran, a pediatrician at St. Louis University in Missouri and one of the study’s authors.

The study found a doubling in the number of children taking medication for type 2 diabetes, with the largest increases seen among pre-teen and teenage girls. The number of asthma prescriptions was up nearly 47 percent.

The findings come from a study of 3 million privately insured children that was designed to be a nationally representative sample. The researchers used the sample to measure increases from 2002 to 2005 in the number of children taking various medicines but did not estimate how many youngsters nationally were on the medications.

There is nothing inherently wrong with giving medication to children with chronic diseases, doctors say, especially when the drugs are shown to be safe and effective. The increase in children receiving asthma medication appears to be partly because more children have asthma, but also because new guidelines recommend using medication in more cases.

The use of cholesterol medication for children appears to have become more accepted as well. The American Academy of Pediatrics recommended last summer the use of statins to lower cholesterol in children as young as 8.

Meanwhile, the federal Centers for Disease Control and Prevention say the number of children with type 2 diabetes is on the rise, but officials do not have estimates for how much. Type 2 diabetes, which used to be called adult-onset diabetes, begins when the body develops resistance to insulin and can no longer use it properly. Eventually, the body can no longer produce sufficient amounts of insulin to regulate blood sugar.

Still, there is an increasing unease in some circles that doctors are prescribing medication without exhausting nonpharmacological options.

“There are concerns that we’re moving too quickly to drug therapy,” said Emily R. Cox, a researcher at Express Scripts, a St. Louis-based pharmacy benefits management company, and lead author of the study. “We don’t know that drug therapy is best for some of these conditions.”

Cox and her colleagues looked at the rates of medication among children ages 5 to 19. They did not look at all medication use, but focused on drugs for high blood pressure, diabetes, cholesterol, asthma, depression and attention-deficit disorders.

Since the study used figures from commercial insurance providers, it did not include the uninsured or those covered by programs for low-income children. Other studies have shown that the urban poor have some of the highest rates of childhood obesity in the United States.

According to the study, antidepressant use was essentially flat, though the numbers have gone down significantly among children under 10. Attention-deficit medication, the proper use of which has long been debated, rose 40 percent, with the largest increase among girls taking medicine for a set of disorders traditionally seen more in boys.

In raw numbers, the number of children on diabetes medication is relatively small, but the findings included one of the more surprising trends, a large number of girls on the drugs. The number of girls ages 10 to 14 on the medication rose 166 percent, and the figure for those ages 15 to 19 rose 133 percent.

One expert said those numbers cannot by accounted for by rises in child diabetes or by a secondary use of one of the drugs, metformin, to treat polycystic ovary syndrome.

“It’s definitely not due to a doubling of type 2 diabetes in children, because type 2 diabetes has not doubled in children and we have data on that,” said Dr. Silva Arslanian, an endocrinologist at the Children’s Hospital of Pittsburgh, who was not involved in the study.

She said overweight children regularly come into the hospital’s Weight Management and Wellness Center on metformin, having been told that they have diabetes, but tests of their blood sugar turn out normal. Arslanian said she believes that some doctors are using metformin, which can lead to appetite loss, as a diet pill – an “inappropriate” use.

“Management of obesity is very frustrating,” she said. “We talk about lifestyle changes, but how many of us are successful in changing lifestyle when the environment is so toxic? When you give somebody a medication, the psychology of the patient is, ‘The medication is doing the job, so I don’t need to change the way I’m eating or moving or drinking.’”

Dr. Debra R. Counts, head of pediatric endocrinology at the University of Maryland School of Medicine, said she does not think that diabetes drugs are being improperly prescribed. She said more children are taking diabetes medication because more children have diabetes. And even though more boys are becoming obese than girls, she said, studies show that girls are more likely to develop diabetes.

“Most pediatricians try not to prescribe medication unless it’s indicated,” she said.

Another reason that more children are being given medications could be that more drugs have been approved for pediatric use in recent years. In the past, doctors in some cases had prescribed the drugs anyway, but many feel more confident now, knowing that proper studies have been done in children.

Medication is not by itself a solution in many cases, especially when it comes to diseases like type 2 diabetes and hypertension, which are most closely linked to obesity, doctors said. Lifestyle changes have to begin as early as possible, Counts said, sometimes even in toddler years.

She noted recent recommendations that overweight 1-year-olds be given low-fat milk as opposed to whole milk. Doctors used to believe that babies needed the fat in whole milk for their brains to properly develop and recommended whole milk until a child’s second birthday.

“We get a lot of kids referred to us. The problem is, we have no magic,” Counts said. “The whole family needs to eat healthier and get more active and turn off the TV. … By the time people are teenagers, it’s hard to change them.”

Posted in addiction, children, cholesterol, diabetes, Type 2, diet, drugs, moral hazard, obesity | Tagged: , , , , | Leave a Comment »

REACH, “atherothrombosis”, and the marketing of Plavix

Posted by Colin Rose on June 23, 2007

An example of a “free” paper in a prominent medical journal reporting a study funded by industry.

Let’s examine what is behind this beneficence.

Disney World

The REACH type subject

REACH is an an acronym for REduction of Atherothrombosis for Continued Health. The term “atherothrombosis” was concocted by “industry” to market Plavix and has now infiltrated into the literature. This is a classic example of marketers inventing a disease for which their drug is the cure. The first and most lucrative was the invention of the disease,”dyslipidemia”, to market statins.

The web site, http://www.atherothrombosis.org, is funded by sanofi-aventis and Bristol-Myers Squibb who sell Plavix. Dr. Bhatt, an author of REACH, is prominent on the site. Here is a quote from the site by a Dr. Cannon:
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Atherothrombosis vs atherosclerosis: Different diseases?

The patients were divided into those who had had a prior event versus those who had not. Interestingly, the patients who’d had a prior event each had about a 20% reduction in death, MI, stroke over the subsequent 2 ½ years in this otherwise pretty stable outpatient population. On the other hand, there was no benefit whatsoever in those who had coronary disease without a prior MI, or cerebrovasculardisease without prior stroke. So, in thinking about this, the question comes up: ‘Does this mean that the patients with a prior event are different?’ They’ve had a thrombotic event as part of their course of vascular disease. The question popped into my head: ‘Would this mean, potentially, that atherothrombosis might be a different disease than atherosclerosis?’

If we circle back to thinking clinically, there are a lot of patients we see who are 80 years old who finally come in with evidence of angina and have diffuse atherosclerotic disease, but who have never had an MI or stroke; then there are other patients who come in at age 40 with a large anterior MI and just one atherosclerotic lesion on their cath. Those would seem to be two extremes: the atherosclerotic patient (the 80-year-old with diffuse disease) and the atherothrombotic patient (the person who comes in with an acute event). And, the difference in the benefit of dual antiplatelet therapy for the atherothrombotic patient makes perfect sense: you’re treating a thrombotic disease with an antithrombotic agent. This may give us insight into subcategorizing a little bit the disease process itself and targeting long-term therapies.
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Readers should be made aware of the disclosure of Dr. McDermott, the editorialist:
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Financial Disclosures: Dr McDermott reports that she has received honoraria from Bristol-Myers Squibb, Sanofi-Aventis, NicOx, and Otsuka Pharmaceutical, has served as a consultant for Hutchinson Technology, and is currently receiving support from research grants from the National Heart, Lung, and Blood Institute.
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Why couldn’t JAMA find an editorialist with no connection to “industry”, particularly the company funding the study which was editorialized?

If you wonder why this is a “free” publication just look at the disclosures and funding:
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Financial Disclosures: Dr Bhatt reports that he has received honoraria for consulting on scientific advisory boards from AstraZeneca, Bristol-Myers Squibb, Centocor, Eisai, Eli Lilly, GlaxoSmithKline, Millennium, Otsuka, Paringenix, PDL, Sanofi-Aventis, Schering Plough, The Medicines Company; honoraria for lectures from Bristol-Myers Squibb, Sanofi-Aventis, and The Medicines Company; and provided expert testimony regarding clopidogrel (the compensation was donated to a nonprofit organization). Dr Röther reports that he has received honoraria from Bristol-Myers Squibb and Sanofi-Aventis. Dr Steg reports that he has received honoraria from Bristol-Myers Squibb and Sanofi-Aventis and has received research grants from Sanofi-Aventis. Dr Steg reports having served as a member of the speakers’ bureau for Boehringer Ingelheim, Servier, GlaxoSmithKline, Merck, Sharp & Dohme, and Nycomed and also on a consultant ad board for AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Sharp & Dohme, Sanofi-Aventis, Servier, and Takeda. Dr Ohman reports that he has received research grants from Berlex, Sanofi-Aventis, Schering-Plough, Eli Lilly, Bristol-Myers Squibb, and Millennium. Dr Ohman reports that he has stock ownership in Medtronic, Savacor, and Response Biomedical and is a consultant for Invoise, Response Biomedical, Savacor, and Liposcience. Dr Hirsch reports that he has received research grants from Bristol-Myers Squibb and Sanofi-Aventis; honoraria from Sanofi-Aventis; and speaker’s bureau fees for Sanofi-Aventis. Dr Wilson reports that he has received a grant from Sanofi-Aventis. None of the other authors reported disclosures.

Funding/Support: The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan), who assisted with the design and conduct of the study and data collection.
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Call me paranoid but I have a suspicion that the conclusion of the next paper from REACH will be that “dual anti-platelet” therapy (read ASA and Plavix) is underused. Thus the “reduction” in REACH.

But the sponsors may have shot themselves in their feet. The REACH data shows that in Japan the use of statins is about two-thirds and hypertensives one-half of the world average but Japanese all-cause mortality is 40% less than the world average. Also the Japanese used about the same “dual anti-platelet therapy” as the world average. So, total mortality has no relation to drug use of all types. This glaring paradox is nowhere mentioned in the paper or the editorial and I doubt most readers will look at the data themselves.

In the final analysis, what is the point in studying atherosclerosis in a population in which 80% are overweight or obese, 44% are diabetic, 82% are hypertensive and 16% are smoking? The causes of their atherosclerosis are obvious, food and/or tobacco addictions as we have known for many years.

If sanofi-aventis and Bristol-Myers Squibb really want to reduce “atherothrombosis” and improve health they should fund programs for fighting these addictions instead of doing more surveys to try to justify more drug sales. From their own data it is clear that drugs do not increase life expectancy.

Posted in atherosclerosis, coronary artery disease, diet, professionalism, Uncategorized | Tagged: , , , , , , , , , , , , , , , , , , | Leave a Comment »

 
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