Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘diabetes’

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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Pfizer abandons “cholesterol”

Posted by Colin Rose on October 1, 2008

After spending tens of $billions in DTC ads and bribes to doctors to terrorize the world into believing that blood “bad cholesterol” is the cause of atherosclerosis, the most common fatal disease, and selling hundreds of $billions worth of Lipitor to lower it, Pfizer has admitted there is no truth to and no more profit to be made from the myth of “dyslipidemia” that Pfizer and other peddlers of statin drugs created. Its much hyped drug, torceptripib, touted as the next Lipitor, which did all the “right” things to blood cholesterol actually worsened atherosclerosis in the ILLUSTRATE trial. Finally, the proof was in that high blood “bad cholesterol” is only a symptom of an atherogenic lifestyle, not the cause of atherosclerosis. But it will take a generation or two for the cholesterol myth to disappear.

So now Pfizer is directing more of its research toward Type 2 diabetes, a disease directly related to obesity, which is directly related to the moral hazard effect created by the cholesterol myth (I can eat anything as long as my cholesterol is low). Very clever marketing! Create diseases, real or imagined, then sell high profit drugs to to “treat” numbers associated with them.


PFIZER REFOCUSES ITS STRATEGY
BY SHANNON PETTYPIECE Bloomberg News
National Post
01 Oct 2008

Pfizer Inc. will abandon early-stage research on heart drugs as part of a strategy to sharpen its focus on ailments such as cancer, Alzheimer’s disease and diabetes where the chances of a bigger profit are greatest. The New York-based company, the…read more…

Posted in atherosclerosis, cholesterol, coronary artery disease, diabetes, Type 2, drugs, obesity, statins | Tagged: , , , , , | Leave a Comment »

Obesity weighs heavy on heart

Posted by Colin Rose on September 22, 2008

Bottom line: obese people have heart attacks at least ten years sooner and have much more diabetes than thin people, regardless of their blood cholesterol. So all those who say fat is OK as long as you are happy are wrong. And all those drug dealers say you are OK as long as you take a statin to lower your “bad” cholesterol are selling you a very expensive mirage.


Obesity weighs heavy on heart: study
SHARON KIRKEY CANWEST NEWS SERVICE
The Gazette
22 Sep 2008

Heart attacks are hitting the overweight more than a decade sooner than ?normal? weight people, researchers are reporting. A study of more than 111,000 people is one of the first to put real numbers to the risk of obesity and suggests ?excess…read more…

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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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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?

Posted in atherosclerosis, coronary artery disease, diabetes, Type 2, diet, drugs, obesity, professionalism | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Drug Dealers Bribe Doctors to Prescribe Statins

Posted by Colin Rose on July 9, 2008

Here is a very important post from Dr. Catey Shanahan documenting direct bribes from drug dealers to clinics who can attract more doctors by paying them more as long as they pledge to get every patient’s LDL below 100. Without major dietary change, counseling for which takes a lot of unpaid time of the doctor, this can only be done by prescibing statins, already the most prescribed drugs in the world. When will the physician licensing bodies stop this corruption of the medical profession and forbid any financial connection of practicing doctors with any industry associated with medical practice?

Unlike Dr. Shanahan, I do blame the doctors. This sort of behavior is highly unprofessional. If no doctor went along with this highly unethical practice, contrary to the Hippocratic oath, it wouldn’t exist.

It seems insurance companies are so occupied with getting $zillions from drug dealers that they can’t be bothered to look at the data. Here are some from the ALLHAT-LLT study. In spite of a large reduction in LDL, bad blood cholesterol, there was no effect on mortality or morbidity in this group of very high risk people including diabetics, all of which the insurance company says should be give statins. Where a bar crosses the vertical line there is no significant effect in that sub-group.

And look at the baseline characteristics of the participants in ALLHAT-LLT: all overweight, 43% obese, 23% smoking, 35% diabetic. Is it not highly unethical to perform a drug study for lifestyle diseases in such a group with obviously atherogenic lifestyles BEFORE optimizing the lifestyles of all participants?

Legal Addictions

An ALLHAT-LLT type subject

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Many of the comments on the NYT and other articles on the new recommendations for pediatricians and family doctors to put children on brain-damaging statins are expressing outrange that drug companies are taking over the minds of doctors. Don’t blame doctors. We’re being threatened by insurance companies. If we don’t do exactly what drug companies want, we’ll be paid less. In some cases, some of us might loose our jobs. (OKay, we do deserve some blame for not standing up for ourselves!)

I went for a job interview in Portland and in a conversation with the medical director of a large group there, I was told that if I failed to get my patients LDL levels down to 100 “someone will sit down and talk with you.” This particular group was able to offer a better starting salary than average. I had assumed that the reason they could offer more was through efficiencies. During the interview, I learned there was more to it than that. They had special arrangements with drug companies called ‘incentive programs.’ The medical director told me with absolute glee “we keep asking them [meaning drug companies] for money and they keep giving it to us.” He sounded like a kid at Christmas!

This group’s policy is to get everyone’s LDL under 100, regardless of risk factors. Stratifying risk is “too complicated.” So they make it simple for their docs. How convenient for the drug companies. I suspect that because this organization has such an aggressive general policy, the drug companies reward them handsomely for taking such a progressive position. They can offer about $50,000 more per year than doctors working in their own, independent offices.

HMSA is Hawaii’s largest medical insurance company. They are paying me to prescribe statins to people who have had heart attacks. Next year, they will pay me to prescribe statins to every single one of my diabetic patients. If I don’t I may loose about $20,000 and my entire group will be penalized financially as well.

If any of this disturbs you, please write to John Berthiaume MD, HMSA Vice President/Medical Director. 818 Keeaumoku Street, Honolulu, HI 96814. Or, you can write to the medical director of your own insurance company and let them know what you think about your payments going into programs that force doctors to write bad prescriptions or loose money!

Posted in atherosclerosis, cholesterol, diabetes, professionalism, statins | 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.

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