Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Archive for July, 2008

Health Centre Food – Not Healthy

Posted by Colin Rose on July 30, 2008

Drs Freedhoff and Stevenson are trying to do what we tried to do more than 20 years ago, change the food policies of hospitals. We have encountered all the same excuses listed below. What has taken us many years to accept and what these doctors fail to realize is that hospitals have no interest in promoting or maintaining health; they exist exclusively to treat disease. If the population were as healthy as they could be by continual vigilance in lifestyle choices there would be very little need for hospitals. Health is not profitable and will not support massive “health care” bureaucracies and unions. From the point of view of the “health care” bureaucracy and “health care” unions the ideal situation is to have a chronically sick but breathing population in constant need of “health care”, profitably supplied by said bureaucracies and unions.

Most hospital have now changed there names to some variation on “health center” and medical systems now call themselves “health care” providers, implying that only these institutions can guarantee health. Whenever I hear this I think or Orwell’s 1984. “War is Peace”; “Disease is Health”. Newspeak can exist in democracies in which self-perpetuating bureaucracies must ensure their survival by thought control and fear of death.

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CMAJ • July 29, 2008; 179

Frying up hospital cafeteria food

Yoni Freedhoff, MD, Medical Director, Bariatric Medical Institute, Ottawa, Ont.

Rob Stevenson, MD, Cardiologist, Saint John Regional Hospital, Saint John, NB

Would you like fries with that angioplasty?” Sadly, this is not as far fetched as you might imagine. Although hospitals are the front line for delivering medical treatment, health promotion and education, paradoxically, the foods they sell are frequently generic versions of fast food staples or, worse yet, brand-name fast food. Remarkably, despite nutrition’s indisputable role as one of our most important determinants of health,1 grassroots calls for hospital cafeteria reform often face resistance from hospital administrators and even some allied health professionals.

In dialogue with hospital administrators, we have met 3 main arguments against hospital cafeteria reform. First, they say they are not the “food police.” The hospital’s role need not be one of policing but rather one of health care leadership. Simply put, the sale of unhealthy foods along with the absence of nutritious alternatives undermine the institution’s role in health promotion. Although we do not propose that hospitals be held accountable for dietary choices, we do feel hospitals have a strong societal obligation to lead by example.

Second, public and institutional sentiment holds that adults are responsible for their own food choices. Consequently some people wonder whether hospitals should be restricted to selling exclusively healthy food. Although this argument has merit,what is not debatable is a hospital’s duty to empower consumers with the information required to make informed choices. Unfortunately, restaurant food choice is anything but informed. Consumers underestimate by 2 to 4 times the saturated fat, calories and sodium content of typical restaurant foods.2 However, providing accurate point-of-sale nutritional information significantly improves consumers’ choices.2 As it stands, with limited or no in-hospital nutritional information available, and frequently no nutritious alternatives offered, hospitals do not enable informed choice.

Finally, there is the question of money. Although Canadian hospitals have fewer fast-food outlets than US centres,3 the transition of their cafeterias from services to institutional profit centres is evident. We have even heard it forewarned that hospital programs could be jeopardized if healthier foods fail to sell. This alarmist warning ignores 2 of a hospital’s most important roles: the mission to promote health and the moral obligation to lead by example. Notably, in its 2007 annual report, the Compass Group, one of the world’s market leaders in retail food service delivery, including hospitals, attributed part of its rising profits to its new focus on healthy eating programs.4

Although there are no established criteria for healthy hospital cafeterias, there are healthy initiatives. California’s Sutter General Hospital enables informed choice by posting the nutritional information for a week’s worth of entrees at the cafeteria entrance. Others serve healthy choices with predominantly vegetarian menus, and there are “farm produce to hospital” programs in Texas, Vermont, North Carolina and Iowa.5 The purpose of the recently launched Canadian Healthy Hospital Cafeteria Project Survey, which one of us (R.S.) helped develop, is to identify Canadian examples of such initiatives.6

Addressing this problem will require a shift in values and thinking similar to when hospitals stopped selling cigarettes and later banned smoking on hospital grounds. Today the majority of our adult population is overweight or obese. In this fight, our dietary environment is the new battleground. Junk food is the new tobacco. Now more than ever, it is our ethical and medical responsibility to ensure that hospitals take the lead in serving foods that reflect evidence-based nutrition.

Thus, we call upon all hospitals as community health care leaders to immediately enable healthy and informed choices in their cafeterias. This would include ensuring the availability of flavourful entrees free of trans fats and low in calories, sodium and saturated fat, as well as posting nutritional information on menu boards and at point-of-sale for all foods. These first steps in cafeteria reform will help hospitals renew their focus on health and put an end to deep-fried hypocrisy.

  1. Kant AK, Graubard BI, Schatzkin A. Dietary patterns predict mortality in a national cohort: The national health interview surveys, 1987 and 1992. J Nutr 2004;134:1793-9.[Abstract/Free Full Text]
  2. Burton S, Creyer EH, Kees J, et al. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health 2006;96:1669-75.[Abstract/Free Full Text]
  3. McDonald CM, Karamlou T, Wengle JG, et al. Nutrition and exercise environment available to outpatients, visitors and staff in children’s hospitals in Canada and the United States. Arch Pediatr Adolesc Med 2006;160:900-5.[Abstract/Free Full Text]
  4. Compass Group. Delivering profitable growth: annual report 2007. Surrey (UK): The Group; 2007. Available: www.compass-group.com/NR/rdonlyres/00F11551-A102-4E1C-AADD-D0DCFD95C723/0/Compass_Report_2007.pdf (accessed 2008 June 23).
  5. Gottlieb R, Shaffer A. Soda bans, farm-to-school, and fast food in hospitals: an agenda for action. Presentation at the American Public Health Association Annual Meeting; 2002 Nov 13. Available: http://departments.oxy.edu/uepi/publications/APHA_Talk.htm (accessed 2008 June 23).
  6. Canadian Healthy Hospital Cafeteria Project Survey. [To complete the survey go to www.surveymonkey.com/s.aspx?sm=CMsk1a3OrVFrbBABU6udgQ_3d_3d (accessed 2008 June 23)].

George Orwell predicted this. "Hospital" is antithetical to the "Health". "Health Centre" implies a protective, nurturing bureaucracy. No one will get sick there.

 

IMG_0194

Vending machines in the McGill University Health (sic) Center

MUHC

Partners in Disease Care. Healthy lifestyles are also not good for union employment.

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Dan, the hospital doctor, is shocked, SHOCKED

Posted by Colin Rose on July 30, 2008

This post appeared recently in the ProCOR list.

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As a medical resident I have encountered an interesting case that raises the question of reversibility and education of the pre/early diabetic group.

The case is of a 38-year-old male that presented to a screening physical examination without any complaints apart from the hardships of life. Past medical history is significant for recent diagnosis of hypertension for which he receives a calcium channel blocker. Family history is positive for type 2 diabete with his father, no coronary syndromes in his family, and his lipid profile is unremarkable. Physical exam reveiled an obese young man (BMI of 33) with controlled blood pressure and the rest of the exam was unremarkable. His initial fasting glucose was >200mg% and soon after HbA1c came back as 12. The patient denied any diabetic related symptoms. The patient was very reluctant to start any kind of diabetic regiment and strongly insisted on a sugar free diet and weight reduction only strategy. The patient went home with his own idea of managing his newly diagnosed diabetes. He did not appear for later follow ups.

But we DID meet again, two months afterwards. This time the patient is with a BMI of 27. He explained to me that he was so shocked from the diagnosis. He just started running around the block and eating a very restricted vegetarian diet. His HbA1C was 6 and fasting glucose levels were normal, and he did return to eating sugar containing foods.

Now he insisted he doesn’t have diabetes. Does he? Was he cured? Did he go back to the pre-diabetic phase? Or is he overt diabetic only controlled by diet? Was the decrease in weight that much of an influence? Apperantely so.

Dan Halpern

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As a resident in the usual hospital environment, Dan has probably been taught that diseases can only be treated with drugs and/or surgery. Coincidentally, these are the acts to which doctors have exclusive rights and for which they can charge high fees. He was shocked, SHOCKED to discover that a patient might know how to treat his own disease without the help of the vaunted American “health care” system and that what he had been taught in the hospital has very little relevance to outpatient practice.

Dan has learned a valuable lesson which he should apply to his future practice. Today most of the fatal diseases are diseases of lifestyle and the only definitive treatment is lifestyle change. Blood glucose, blood lipids, blood pressure, etc. are all markers of lifestyle in the vast majority of cases, not diseases to be treated with drugs until lifestyle has been optimized. There is increasing  evidence that some of these markers may actually be protective responses to nutritional stress analogous to a fever in response to an infection. Obviously there are varying genetic predispositions to the effect of self-destructive lifestyles but as they say, genes load the gun, environment pulls the trigger.

So, yes, Dan’s patient did cure himself of Type 2 diabetes and probably hypertension as well. He probably doesn’t need any drugs.

Now if we could only get all doctors to treat lifestyle diseases with lifestyle change before prescribing drug of doing operations we could save hundreds of billions of dollars in disease care costs, close many hospitals, shut down many drug companies and many doctors would have to make a living actually talking to patients. Isn’t that the essence of being a professionial?

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Free Online CME – Drug Dealers’ Propaganda

Posted by Colin Rose on July 26, 2008

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

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?

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

Liposuction Can Be Deadly

Posted by Colin Rose on July 25, 2008

Liposuction is a totally useless procedure in terms of preventing or treating any disease and has risks as this article shows. A size 6 women who was obsessed by small collections of subcutaneous fat should never have had this procedure. Indeed, no doctor should ever perform liposuction on anyone and, in general, any out-of-hospital cosmetic surgery requiring general anesthetic should be banned.



Beautiful inside and out

BY MELISSA LEONG
National Post
24 Jul 2008

Thirty-two-year-old Krista Stryland, a mother and successful Toronto real estate agent, went to a private clinic for liposuction, apparently to remove fat following the birth of her three-year-old son.

Hours later, court documents allege, she lay in a recovery room for 30 minutes without vital signs after a procedure that drained fat from 23 incisions in six different parts of her body.

She was pronounced dead in hospital on Sept. 20, 2007.

Her sister says she was a size 6. She says the doctor should have told her that she did not need liposuction.

After Ms. Stryland’s death, Ontario’s medical watchdog introduced stricter regulations governing family doctors who perform cosmetic surgery.

It launched an investigation of Dr. Behnaz Yazdanfar, the physician who performed Ms. Stryland’s operation. But the doctor is fighting the College of Physicians and Surgeons of Ontario in court, claiming its investigators cannot force her to give them an interview or observe her procedures.

This week, a Superior Court judge deferred the case but acknowledged the hardship that these kinds of delays can cause loved ones.

Ms. Stryland’s family has raised several concerns with the college, including Dr. Yazdanfar’s alleged failure to warn of risks, leaving Ms. Stryland “with the impression that this was a routine benign procedure.”

“She was a size 6. Someone who is a size 6 doesn’t need liposuction,” Ms. Stryland’s sister, Melissa Cavelti, said. “The doctor should have just told her, in the first place, that she didn’t need it.”

Her close family members have declined requests for interviews. They feel heartache every time they see a photo of her in the media or read the details from her medical records.

“We want the focus to be on the problems in the health care system and not on Krista,” Ms. Cavelti said. “Hopefully, they can work to improve [it] and something good can come out of this.”

The family wrote to the college about Dr. Yazdanfar’s Web site. Dr. James Edwards at the Office of the Coroner had similar concerns. “Any reasonable member of the public would think that Dr. Yazdanfar was a certified surgeon on her Web site. This is disingenuous,” he told a college investigator.

According to court documents released this week, investigators with the college first began looking at Dr. Yazdanfar’s practice in 2002 after another physician told them she was performing surgical cosmetic procedures in her office. All doctors who are registered with the college “may practice only in the areas of medicine in which [he or she] is educated and experienced.”

On Oct. 21, 2002, Dr. Yazdanfar told investigators she had taken a course in liposuction in Colorado in the spring and had performed 30 procedures since. She said she removed only one to two litres of fat at a time.

The following year, an expert hired by the college deemed her training to be adequate. She later informed the college she wanted to begin performing breast-implant surgery after training in Indiana.

On Sept. 20, 2007, Ms. Stryland’s former husband and the father of their young son dropped her off at the Toronto Cosmetic Clinic.

After the procedure, she was sitting up in the recovery room and being offered cookies by the nurses, Tracey Tremayne-Lloyd, the lawyer representing Dr. Yazdanfar, said. They suddenly noticed that she seemed less alert and an anesthesiologist began treating her, Ms. TremayneLloyd added, citing medical notes.

Ms. Stryland’s former husband called the clinic twice wanting to know when he could come to pick her up, according to a written complaint to the college from the family.

The first time, he was told the surgery went fine and that Ms. Stryland was in recovery and feeling “groggy.” The second time, a staff member promised to call him back.

He arrived at the north Toronto clinic and found paramedics attending to Ms. Stryland. He was told that she had “lost a little more blood than they had hoped.”

She was transported to a hospital, which contacted Dr. Sean Rice, a plastic surgeon. He was asked to examine a patient who was in cardiac arrest.

It was his understanding, he later told college investigators, that she had been at the clinic without vital signs for 30 minutes before an ambulance was called.

Ms. Tremayne-Lloyd said that is “complete and utter nonsense.”

When paramedics arrived, “she had a blood pressure, she had a pulse, her respiratory rates were being recorded — this patient was not lying in recovery for 30 minutes without vital signs. We can find no reference to it in any of the charts,” she said.

Court documents allege that 2.7 litres of fat were drawn from 23 incision sites.

“ There were puncture wounds where no physician would put one,” Dr. Rice told the investigator.

While hospital workers tried to resuscitate Ms. Stryland, Dr. Rice called Dr. Yazdanfar and asked what happened.

“I am a very good surgeon. I do this all the time,” she said, according to Dr. Rice’s report to the college.

“Could you have punctured an organ?” he asked. “I’m an excellent surgeon.” Dr. Yazdanfar then asked how Ms. Stryland was doing.

“I stated that it appeared that Mrs. Stryland was not going to survive,” he said.

Dr. James Edwards at the coroner’s office told the investigator that Ms. Stryland had liposuction on both legs, buttocks, back, abdomen and chest wall. He thought that the number of locations for fat removal may have contributed to her death.

Dr. Yazdanfar has not been charged in connection with the death and the allegations have not been proven in court.

Ms. Stryland, by all accounts, was a rising star at her real estate company and a devoted mother. She attended Havergal College, one of Toronto’s oldest and most prestigious girls’ schools, and later studied at Concordia University in Montreal.

Friends, former clients and classmates continue to write on a Facebook page dedicated to her; someone posted a message as recently as Tuesday.

“Her smile was contagious,” one person wrote.

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Medical Devices – No Controlled Trials

Posted by Colin Rose on July 24, 2008

“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?


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.”

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Medical Terrorism – The Chaoulli Decision

Posted by Colin Rose on July 20, 2008

Another example of medical terrorism and the big lie, this time from the surgical contingent. The Chaoulli  decision by the Supreme Court of Canada is misnamed. It should have been called the Doyle decision. Dr. Daniel Doyle, a cardiovascular surgeon, testified that patients waiting for a coronary bypass are “sitting on a bomb” and could “die at any moment”.

Where he got the figure of 0.45% per month mortality on the “waiting list” is a mystery. Mortality on the waiting list for elective coronary bypass is at most 1% per year, about the same as the general population of the same age group. He didn’t say and wasn’t asked about the mortality for a bypass operation, about 3%!

The judges seem to have been struck dumb by terror and lost their cool at hearing this. They forgot the old adage, “you don’t ask a barber if you need a haircut”. They didn’t even think to ask Dr. Doyle if surgery would actually prevent the rare deaths on the waiting list. As we know from the MASS-II trial mortality is the same for surgically and medically treated patients with stable coronary disease who, by definition, comprise the “waiting list”. So, a basic principal of Canadian medicare system, that all citizens should have equal access to disease care regardless of ability to pay, was instantly destroyed by the terrorist statements of a surgeon and irrational fear of death. Remind you of Ancient Egypt?

Medical terrorism. This was almost a full page size on the front page of the National Post the day after the decision. Note the ECG tracings at top and bottom. Implication? Your ECG will flat-line and you will die of heart attack because of public health care.

We look down on the Ancient Egyptians for their believe in the afterlife and the huge waste of resources that went into preparing for it. Are we really that much different? We might not believe in the afterlife but we put even more wasted resources into the futile attempt to live forever on Earth. The drug dealers and surgeons are only too happy to oblige.

Open Heart Surgery

Coronary Bypass Operation

Here is the Ancient Egyptian version of the "coronary bypass", a means of living forever administered by a secretive, priestly class. The heart was removed to be weighed against a feather representing Ma'at to determine moral righteousness. The brain was sucked out of the cranial cavity and thrown away because the Egyptian's thought it was useless. Personal belongings were usually placed in the tomb to make the Ka more at home and to assist the dead in their journey into the afterlife

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Statins in Women – Useless

Posted by Colin Rose on July 18, 2008

Generally, I’m not a great fan of meta-analysis but if the drug dealers want to play the game anyone can.

On the average women have heart attacks about 10 years later than men but more women than men die from coronary disease. In this meta-analysis from JAMA statins do not reduce total mortality in women in either primary or secondary prevention. They haven’t even been proven in a good controlled trial to prevent “events” in secondary prevention. So until there is a good RCT of statins in women I will not prescribe them for any women without xanthomas.

Dr. Pignone is noted as having received research support from Pfizer and Bayer. I would bet that after publishing this paper he won’t get another cent from the drug dealers.

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DIRECT. More obese liars.

Posted by Colin Rose on July 16, 2008

We have already commented on a similar diet study, A to Z. Again with DIRECT (DIetary RandomizEd Controlled Trial) we have another attempt to prove the Atkins diet is better but is really another demonstration of lying by most overweight and obese people. Any study on diet and energy balance that cannot first demonstrate that the First Law of Thermodynamics is obeyed from self-reported data is totally unreliable and unreproducible and should never be published.

While the data as presented are hard to interpret in terms of detailed energy balance because daily energy intake and expenditure is not reported, as it should have been, the subjects claimed to be doing more exercise and eating less but only lost 10 pounds in two years. The prescribed diets contained 1800kcal for men and 1500kcal for women. These values are close to the basal metabolic rates of these mostly obese people. They should have lost weight continuously and markedly during the trial. Let’s see how much they should have lost if they were reporting accurately. They claimed to be eating about 500 kcal less than baseline per day on all diets. Even doing the same amount of exercise they should have lost about a pound per week (one pound of fat is about 3500 kcal) or about 50 pounds per year or 100 pounds in 2 years. Since they claimed to be doing more exercise they should have lost even more. If they had been telling the truth, most participants should have starved to death well before the end of the study! Ergo, most overweight and obese people lie about food intake and exercise; they tell investigators what the investigators want to hear.

Obesity is and always has been caused by junk food addiction. Until we deal with that, the pandemic of obesity and its terrible consequences will only worsen. Unlike most infectious diseases, there is no vaccine against  addictions. We all must make the right choices as to what we put into our bodies. In developed capitalist democracies resisting the self-destructive temptation to consume all manner of cheap addictive substances or to adopt addictive behaviours readily supplied by highly profitable enterprises is the hardest task we have. And how to deal with it is not taught in medical school.

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That obese people lie about food intake was proven beyond doubt by a study using doubly-labeled water to measure true energy expenditure. About 65% of these subjects were overweight or obese. They claimed to be eating only about 1500 kcal/day, about 40% less than they actually ate, but were burning 2500. So, they should have had a deficit of 1000 kcal/day and be losing weight dramatically but their weights were stable. Ergo they were “misreporting”, a euphemism for lying.

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Disney World

Is she on a low-fat or low-carb diet?

Posted in diet, obesity | Tagged: , , , , , , , , , , , , , | 25 Comments »

The Spread of Obesity

Posted by Colin Rose on July 16, 2008

The Framingham study is a very detailed picture of the population of a small town in Massachusetts. Below is a series of diagrams showing the relationships between people and their BMI status from a paper in the New England Journal of Medicine. It is the first really detailed picture of the start of the obesity pandemic. Green circles are BMI less than 30 and yellow circles BMI greater than 30, the official definition of obese. The authors were interested in the “transmission” of obesity between friends and relatives but never advanced an hypothesis for what would have initiated the epidemic and what might have fueled it.

In 1975 there was not a single obese person. From 1980 to 1985, the era of the cholesterol-lowering resins, like Questran, the first obese people appear. The LRC-CPPT results were published in 1984. By 1990 after the introduction of statins the incidence of obesity accelerates until by 2003 more than a third of the population is obese. There is no other plausible explanation for this phenomenon. People stopped caring about controlling calorie intake in the belief that lowering blood cholesterol with resins or statins would save them from the well-known consequences of gluttony. This attitude spread in families and between friends in the classical pattern of a transmissible virus or bacterial infection. It was OK to eat anything and to be obese if everyone else was and you took your pills.

If there is a better explanation for the obesity pandemic, we would like to hear it. None of the usual suspects, fast food, cars, suburbs, television, computers, the Internet, dangerous neighborhoods, etc. explain why people just eat too many calories and don’t care enough to control consumption.

See our photo essay on food addiction for a graphical demonstration of the obesity pandemic.

An epidemic of obesity

An epidemic of obesity

United We Stand, Disney World

Disney World. United We Stand. To the outside observer Disney World in Orlando appears to be a social club for the obsese and morbidly obese.

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Drug Marketing by Acronym. ACCORD and the Power of Myth

Posted by Colin Rose on July 14, 2008

CHRISTMAS, COURAGE, DIAMOND, DREAM, ILLUMINATE, ILLUSTRATE, REACH, PARAGON, PRAISE, PREVENT, ONTARGET, PROVE IT, ENHANCE, ACT, BEST, ADVANCE, HOPE, LIFE, PROSPER, CALIPSO, ASTEROID, ACCORD, CASHMERE, MIRACL, SYMPHONY, all names of recent drug studies that are carefully constructed pseudo acronyms invented by highly-paid marketers, implying that the drug studied has wonderful properties to prolong your life make it much more pleasant and worry-free. The marketers have learned that the name of the trial is more important than the results of the trial. Who would be attracted to older trials named WOSCOPS or LRC-CPPT? Would it really matter what the results of DREAM were? The acronyms imply that regardless of the result of the study the drug must be good for something. If one fiddles the statistics one can always find a sub-group in which the drug had some effect. You will never see a drug trials with the acronyms, DISEASE or DEATH but many of them do result in more of either of both.

To take one example, just the association of a drug with a trial like ACCORD (Action to COntrol Cardiovascular Risk in Diabetes) will give it cachet. But the results of the drug “action” in ACCORD was that  adding more expensive drugs to the usual cocktail to markedly lower blood glucose to an arbitrary “target” in type 2 diabetics with known vascular disease caused more deaths than not meeting the “target”. The latest expensive drugs for DM2 were supplied by the usual suspects: Abbot Laboratories, Amylin, AstraZeneca, Bayer Healthcare, GlaxoSmithKline, King Pharmaceuticals, Merck, Novartis, Sanofi-Avenis, Schering-Plough. Seven of the lead authors have received drug money from multiple companies. But will the results of this study made a dent in the sales of the latest heavily-marketed, expensive drugs like Diamicron, Prandase (Precose), Amaryl, Avandia (Actos), and Byetta? Not likely. As an apologist for the drug industry who receives money from Amylin and Merck, stated in an editorial in the New England Journal of Medicine, this study “…[does] not provide a definitive answer to the problem of glycemic control and cardiovascular disease. Other ongoing clinical trials will provide additional clarification.” More dead people when taking more drugs is not clear? One of the studies we are to await is, wait for it, ORIGIN. Reminds one of the Garden of Eden. So, the myth of the necessity to “normalize” symptoms or metabolic self-abuse that might even be protective will persist and these unproven drugs will continue to be prescribed for many more years costing the medical systems of the world many $billions and making huge profits for their makers, in spite of the total absence of proof that anyone is better off or living longer swallowing these drugs.

Legal Addictions

The ACCORD-type subject

These drugs were approved for sale purely on basis of their ability to lower blood glucose, a symptom of a self-abusive, atherogenic lifestyle. Look at the baseline characteristics of participants in ACCORD. Average BMI was 32. Obese is defined as BMI greater than 30. So almost all participants were obese. Is it not unethical to perform a drug study in such a group before they have all reduced their BMIs to under 25? Normalizing their weights, by far the most important “action”, would probably cure the diabetes in many of them and they wouldn’t even be in a study on diabetes. But one cannot sell drugs to healthy people. So why would any investigator receiving money from drug dealers insist that people with self-abusive lifestyles change their lifestyles before doing a drug trial? After all, no investigator wants to risk dying of old age before he or she can collect enough “events” (i.e. deaths) to write a paper whatever the conclusion might be.

Results from ACCORD. More deaths on “intensive” (more expensive drugs) therapy

Drs Krumholz and Lee, both with no ties to drug dealers write in a Perspective article in the same issue of the NEJM. “Clearly the way in which risk factors [blood cholesterol, blood glucose, high blood pressure] are modified does matter. Lifestyle interventions may [sic] have few risks, but we cannot assume the same for drugs…”  “…ultimately we need to understand a strategy’s effects on people, not just on surrogate end points.” But even they refuse to recognize the absolute need for lifestyle change before starting drugs in patients with diseases of lifestyle. What risks could lifestyle change possibly have?

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