Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Archive for the ‘moral hazard’ Category

“When diet doesn’t work”

Posted by Colin Rose on September 21, 2009

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

LescolItaly2008-04

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.
For example, see the above 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!”

Posted in atherosclerosis, cardiology, cholesterol, diet, drug marketing, drugs, food, junk food, moral hazard, statins | Tagged: , , | Leave a Comment »

WHAT YOU EAT MAKES YOU FAT

Posted by Colin Rose on September 13, 2009

Great article, Joe. We appreciate there are those that are confused. But there are also large numbers who know what is healthy to eat, but easily blind themselves to reality; they are junk food addicts. That “food”  that the cruise passengers are piling on their plates is specifically formulated to appeal to addictions to sugar, salt and the mouth feel of fat. Unfortunately, treating junk food addiction is just as hard as treating addictions to tobacco, cocaine or heroin. Doctors are not trained to and not paid to treat addictions. They are paid to “treat” the symptoms of junk food addiction, like hypertension, Type 2 diabetes and “cholesterol” and do futile gastric bypasses. “Treatment” of these symptoms deceives the addict into believing that s/he can avoid the consequences of the addiction and makes the addiction worse. Americans are inundated with direct-to-consumer (DTC) drug advertising, claimed to be a First Amendment right by corporations with $billion ad budgets, promoting this deception and doctors are paid to prescribe those drugs.  Canada is catching up fast. Obesity rates are rising and there is pressure from the media to allow DTC in Canada, presumably guaranteed by the Bill of Rights.

The solution? Each individual has to balance the transient pleasure of addiction against the long term disastrous consequences of the addiction. In our society this is the hardest thing most people have to do 24/7/52 for a lifetime and doctors must avoid aggravating addictive behaviour.


WHAT YOU EAT MAKES YOU FAT
JOE SCHWARCZ
The Gazette
13 Sep 2009

Occasionally, I like to spy on people. Only for the sake of science, of course. And what better opportunity to do that than on a cruise ship? I like cruising. Besides outstanding entertainment, impeccable service, interesting ports, activities galore…read more…

 

Posted in addiction, diet, drugs, ethics, food, junk food, lifestyle, moral hazard, obesity, professionalism, statins | Tagged: | 2 Comments »

Once-a-day trap

Posted by Colin Rose on March 30, 2009

Not mentioned is the moral hazard effect of taking any pill that one thinks will obviate the need for constant vigilance in lifestyle choices. The deceptive hype behind multivitamins and “cholesterol” pills has been largely responsible for the pandemic of obesity and Type 2 diabetes.


Once-a-day trap
BY JULIE BEUN-CHOWN Canwest News Service
National Post
30 Mar 2009

Joe Schwarcz is known for his blunt, take-noprisoners style when he gets fired up. For the past 25 minutes, the erudite director of McGill University’s Office for Science and Society and outspoken star of the Dr. Joe Show on Toronto’s CFRB radio has…read more…

Posted in diabetes, Type 2, diet, drugs, junk food, lifestyle, moral hazard, obesity | Tagged: , | Leave a Comment »

Escaping the dungeon of our own desire

Posted by Colin Rose on February 27, 2009

Why do we need to keep having to prove for ourselves that Seven Deadly Sins, codified 1500 years ago are still valid? Every few generations we forget the power of the addictions to which the human brain is prey and become convinced that some form of technology will save us from the consequences of self-destructive lifestyles. One hopes we and our descendants have learned the lesson that constant vigilance is lifestyle choices is and will always be essential, regardless of the technological sophistication of a society.


Escaping the dungeon of our own desire
MICHAEL GERSON Washington Post Writers Group
National Post
27 Feb 2009

There is now a minor but raging academic debate taking place over the effect of an economic downturn on your health. In the traditional view, unemployment can cause a kind of recession flu — a funk that leads to stress-smoking, unhealthy comfort foods…read more…

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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 »

Rate of increase in Type 2 Diabetes in UK doubles in one year

Posted by Colin Rose on October 24, 2008

Has anyone considered the possibility that this disaster might be because the UK is the only developed country to have made statins non-prescription drugs? This is truly a revenge of unintended consequences. Just take your statin and eat anything. Result? An epidemic of obesity whose consequences are as bad or worse than the disease the statins were supposed to prevent.

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From The Independent

Diabetes may cause first fall in life expectancy for 200 years

By Jeremy Laurance, health editor
Monday, 20 October 2008

Britain is in the grip of a diabetes epidemic that threatens to overwhelm the NHS and could lead to the first fall in life expectancy in 200 years. The number of cases diagnosed has doubled in a year, figures out today will show. Family doctors recorded an extra 167,000 sufferers last year, compared with a rise of 83,000 in 2006-7.

The increase brings to almost 2.5 million the number of British diabetics. A further 500,000 people are thought to be affected but unaware of their condition. The condition shortens lives by 10 years and is a leading cause of circulatory problems and blindness.

The soaring rate of diabetes is driven by rising obesity. Today’s figures from Diabetes UK show five million people are registered as obese by their GPs, up from 4.8 million in 2006-07. At least a million more Britons are predicted to succumb to diabetes by 2010.

Professor Sir George Alberti, a Government adviser and former head of the International Diabetes Federation, said the accelerating increase was partly due to improved screening but also to a genuine rise in cases.

“It is a clarion call for society to take this seriously,” he added. “The catastrophe has started to happen. The Government has begun to tackle obesity and inactivity but converting good words into action is very difficult. It will take ages to have an effect.”

The World Health Organisation has predicted that deaths from diabetes in Britain would rise from 33,000 a year in 2005 to 41,000 by 2015 but Professor Alberti said that figure underestimated its true impact. More than 80 per cent of sufferers die from heart attacks or strokes and more than 1,000 a year suffer kidney failure requiring dialysis.

“The WHO figure [for deaths] was very conservative,” he said. “Large numbers die from heart disease and strokes [linked with diabetes] and they do not include those.”

Diabetes is spreading around the world, fuelled by increasing urbanisation and the spread of Western lifestyles. It is estimated to have killed 2.9 million people in 2000, equivalent to the number of Aids deaths, although it has received a fraction of the attention. From 170 million people affected in 2000, doctors predict the total will rise to 370 million by 2025, leading to an epidemic of blindness and amputations.

Researchers have warned that the increase in diabetes and other chronic diseases driven by rising obesity could lead to a fall in general life expectancy. Writing in the New England Journal Of Medicine in 2004, Jay Olshansky and colleagues at the University of Illinois said life expectancy could be cut by five years in the coming decades if obesity continued to increase. Douglas Smallwood, chief executive of Diabetes UK, said: “These are truly alarming figures. Part of why we have seen such a huge increase can be attributed to improved screening from healthcare services and greater awareness amongst those at high risk of type 2 diabetes. However, there is no getting away from the fact that this large increase is linked to the obesity crisis.

“Diabetes is one of the biggest health challenges facing the UK. It causes heart disease, stroke, amputations, kidney failure and blindness and more deaths than breast and prostate cancer combined. The NHS already spends £1m an hour on diabetes. The soaring diabetes prevalence will continue to put a massive strain on an already struggling NHS and, unless it can respond, people’s health could spiral downwards. We need to do all we can to raise awareness of the seriousness of diabetes and help people understand how a healthy lifestyle can help reduce their risk.”

Diabetes is a disorder in the metabolism of carbohydrate, leading to excessive thirst and the production of large amounts of urine caused by lack of insulin. Nine out of 10 sufferers have Type 2 diabetes, which usually affects older people but is now seen in younger people and children as weight has risen. The risk is 10 times higher in those who are obese, defined as having a body-mass index of more than 30.

Diabetes: The risks, the costs

*The condition causes blood-sugar levels to rise because of a lack of insulin. The risk is 10 times higher in people who are obese.

*Raised sugar levels lead to high blood pressure, increased risk of heart attack, stroke, blindness, kidney damage and ulceration of the feet.

*It costs the NHS £1m an hour to treat. One pound in every £10 spent on the hospital service is for diabetes and its complications.

*Type 2 diabetes can be treated by diet and exercise and the effects are reversible if the damage has not gone too far.

*In more severe cases, drug treatment with tablets or injections of insulin is necessary.

*For up to 10 years, there are no symptoms, but doctors believe that the earlier that treatment begins, the less damage it causes.

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