Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘statin’

“Health” spending in Canada hits $172-billion, outpacing inflation

Posted by Colin Rose on November 14, 2008

Drugs now cost more than doctors and the cost is rising faster than inflation. Sooner or later this insanity has to end. Probably sooner. With a likely world-wide depression in the next few years there will be awakening awareness that most of those expensive branded drugs, such as Lipitor and Crestor, are for lifestyle diseases, like Type 2 diabetes, hypertension and atherosclerosis, related to junk food addiction which can be prevented and treated without drugs. But we need to take a $few billion of that $172 billion and put it into addiction research. Addictions of many kinds are at the root of most of the problems of developed capitalist democracies.

Note that Japan which spends per capita on its “health care” system only 38% of the USA and 70% of Canada has a longer life expectancy than either. Ergo, there is no relation between money spent on hospitals, drugs and doctors and life expectancy; if any, there is an inverse correlation. While everyone uses the term “health care” for the activities and effects of hospitals, drugs and doctors, these are really disease care. Some diseases can be cured but most can’t and in a high tech, fee-for-service medical system with an incentive only to do more, more people will be killed by the technology than saved by it.

Jeffrey Simpson in the Globe and Mail suggests as a solution to exponentially increasing costs more private “health” care. That will only increase the total cost as people with just spend more to support their addictions. Doctors in a fee-for-service regime will be only to happy to oblige. The only long-term solution I can see is to put all doctors on a salary. In such a system the driving incentive is to keep people healthy so doctors have less work to do. Paying doctors per disease is like paying firemen per fire. Would there be more or less fires? Would there be any incentive for fire departments to promote fire prevention? In a regime of totally salaried doctors costs would drop dramatically and the health of the population would markedly improve.


Health spending hits $172-billion, outpacing inflation
BY BRADLEY BOUZANE Canwest News Service
National Post
14 Nov 2008

OTTAWA  Health care in Canada will cost $172-billion this year, or nearly $5,200 for every person in the country, according to figures released yesterday by the Canadian Institute for Health Information. The independent statistical agency says that…read more…

cihi-canada-world-healthcare-cost
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From the Globe and Mail, November 19, 2009

Listening to the sounds of health-care silence

JEFFREY SIMPSON

Where did health care go? Pollsters keep reporting that health care is the No. 1 issue for Canadians. We spend way more on it than on anything else. Yet, no one – well, almost no one – talks about it any more, at least not politically.
Sure, citizens recount their experiences with the system to each other. People who work in the system talk about it incessantly, health care being their world.
But as a public policy/political issue, health care has died. Died, despite the Canadian Institute for Health Information’s reporting last week that Canada will spend $172-billion this year on health, about 70 per cent from public sources. That works out to $5,170 per capita.
Health care gobbles up provincial (and federal) resources. It consumes 39 per cent of all provincial program expenditures – that is, spending on everything but  servicing the debt. In some provinces, health care’s share of program expenditures is 45 per cent. Soon, it will be 50 per cent and higher in all of them.
Health care consumed 7 per cent of the nation’s economic output in the mid-1970s, shortly after it was up and running. Now, it consumes 10.7 per cent. That share will keep on rising as the population ages, technology becomes more expensive, and demand grows.
No one knows how to stop the increase; in fact, large increases are hardwired into government spending plans. These increases are not improving the system, but they are keeping it from getting discernibly worse.
The Paul Martin government signed a deal with the provinces for a $41-billion transfer from Ottawa over 10 years starting in 2004-2005, with the transfer indexed yearly to 6 per cent. The Harper Conservatives, then in opposition, signed on to that deal and have never wavered.
Without that federal cash, provincial health-care plans would be struggling or imploding – or provinces would be forced to raise taxes or cut other services. As it is, their annual costs are rising by 4 per cent to 5 per cent after inflation. The federal cash keeps their systems afloat.
That’s one reason why silence surrounds the health-care debate. Caterwauling provinces can hardly complain about parsimonious Ottawa when such mighty rivers of federal cash are flowing their way. Similarly, almost complete silence reigns within federal politics, except for occasional election promises to spend  yet more money for provinces to hire more doctors. But with Ottawa already sending so much money to provincial capitals, these chirpings ring hollow.
It was cheap theatre for provinces to beat up on Ottawa when the federal government seemed to be rolling in dough. But after the Harper government spent the surplus it inherited by shovelling money to the provinces for the ‘fiscal imbalance,’ cut federal revenues through reductions to the GST and let spending proceed above the inflation rate, the surplus almost disappeared.
Now, with the economic tsunami upon us, the small surplus will head into deficit. Even if provinces clamoured for more health-care money, there wouldn’t be any.
The deeper reason for the silence is that no provincial government knows what to do about the system, except to keep it going, fiddle at the edges, try to improve administration here and there, negotiate the best collective bargaining agreements they can.
Nowhere in Canadian public affairs is the gap so wide between what those responsible for policy say and what they do. Privately, almost all of those responsible know that the spending increases are unsustainable and that some means must be found to allow more public services to be delivered privately.
Publicly, none of them dare say so.
Without that debate – and fear of public reaction keeps it closed – politicians spin their wheels, spend lots of money, patch the system, add something new here and there, and carry on.
The only idea for lowering the increase in health-care costs comes from those who claim, rightly, that the fastest-rising part of health-care budgets is the drug bill. Their answer: a national pharmaceutical plan integrated into medicare.
It might be recalled that, in 1997, Quebec introduced such a drug plan. It cost the treasury about $700-million that year. This year, the public cost will be $2.3-billion, a threefold increase in about a decade.

Posted in atherosclerosis, diabetes, diet, drugs, statins | Tagged: , , , , , , , , , , , , | 1 Comment »

CRP is only a marker and does not cause disease

Posted by Colin Rose on October 29, 2008

Dr. Paul Ridker, the inventor of a method for sensitively measuring C-reactive protein, has made a career and much money flogging the notion that C-Reactive protein, produced in the liver in response to various physiological stresses like inflammation and abdominal obesity, is the cause of atherosclerosis and must be treated. Ridker’s web site promotes the wonderful benefits of measuring hsCRP and “treating” it with drugs, most notably statins. He has been successful in convincing most cardiologists and family doctors that hsCRP is and essential measurement in assessing “risk”. However, there was never any proof that doing so would prolong life or prevent any disease.

But a clever non-American group in Copenhagen, remembering the basic rule that correlation is not causation, refused to be intimidated by Ridker’s arrogant, industry-funded propaganda and showed that people with genetic abnormalities that raise blood hsCRP without inflammation do not have more atherosclerosis. Like blood cholesterol, CRP is just another marker of an atherogenic lifestyle and excess visceral fat. Both of these responses to nutritional stress may actually be protective.

As a corollary we can also conclude that “treating” blood hsCRP with statins is futile.

In case Ridker’s web site is taken down in embarrassment, here is what Ridker’s site looks like so that posterity can see an example of the destruction of another profitable medical myth.

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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.

Posted in atherosclerosis, cardiology, cholesterol, coronary artery disease, drugs, statins | 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!

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Statins added to WHO list of “essential” drugs

Posted by Colin Rose on May 10, 2007

Well, it finally happened. The statin peddlers convinced WHO to add statins to the list of essential drugs.

But look at who was behind the initiative, Dr Gotto

Dr. Gotto receives many thousands of dollars from statin peddlers.

Here is a disclosure statement from a recent publication

“Antonio M. Gotto, Jr., MD, DPhil, serves as a consultant for
AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson-Merck, Kos
Pharmaceuticals, Kowa, Merck & Co., Inc., Merck-Schering Plough,
Novartis, Pfizer Inc, and Reliant Pharmaceuticals.”

Surely this should have been mentioned in the Cornell press release.

Personally, I refuse to take any advice from anyone who receives even one cent from a drug dealer.

I completely agree with Dr Kishore’s statement:

“Increasingly, ‘Western’ high-fat diets, tobacco use and urbanization have
helped make heart disease a bigger killer than ‘The Big Three’—HIV/AIDS,
tuberculosis and malaria—combined.”

Indeed, high risk individuals have high risk lifestyles.

But the FIRST thing to do is change the diet and eliminate tobacco BEFORE labeling statins essential drugs. To do otherwise will reduce any incentive to improve lifestyle and make the obesity and diabetes pandemic even worse.

Do you think that the “developing” world is going to be happy with generic simvastatin? Not likely. They are going to start demanding patented Crestor and Vytorin, just like the rich Americans.

Cubans take no statins but live longer than Americans? If statins are not essential in Cuba, why should they be in Africa?
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Weill Cornell Medical College Students Help Change Global Health Policy

NEW YORK (May 21, 2007) – In a move to improve global public health, Weill
Cornell Medical College students have helped place a lifesaving heart
disease drug onto the World Health Organization’s (WHO) list of essential
medicines. This list is a guideline for developing countries to choose which
high-priority drugs should be supplied to their citizens inexpensively.

Students from Weill Cornell’s chapter of Universities Allied for Essential
Medicines (UAEM) answered the charge of Dr. David Skorton, President of
Cornell University, and Dr. Antonio M. Gotto Jr., dean of Weill Cornell
Medical College, to “seek new strategies for Cornell to advance public
health” across the globe.

“I am extremely proud that the students at Weill Cornell Medical College
have had such an admirable influence on global health policy,” says Dr.
Skorton, who is also a professor of internal medicine and pediatrics. “Such
actions by our students show the promise of their future leadership.”

“Adding this medicine to the list of essential medicines represents an
exceptional achievement by our students,” says Dr. Gotto, an internationally
renowned expert in heart disease prevention, who served as the senior
advisor for the project. “Because of the students’ success, over 150
national governments that work with WHO will be encouraged to recognize
heart disease as a serious health concern deserving of great medical
attention.”

UAEM comprises a national group of students whose goal is to determine how
universities can help ensure that biomedical products, including medicines,
are made more accessible in poor countries and further the amount of
research conducted on neglected diseases affecting the poor.

“For years, it was thought that heart disease was a concern of affluent
countries. But, today, nearly 80 percent of all deaths due to heart disease
occur in the developing world,” says Sandeep Kishore, an MD-PhD student at
Weill Cornell Medical College who helped spearhead the initiative with UAEM.
“Increasingly, ‘Western’ high-fat diets, tobacco use and urbanization have
helped make heart disease a bigger killer than ‘The Big Three’—HIV/AIDS,
tuberculosis and malaria—combined.”

Kishore and Ben Herbstman, UAEM members, petitioned WHO that simvastatin
(Zocor)—originally manufactured by Merck—be added to the list. Simvastatin
was selected based on its worldwide availability, cost-effectiveness and the
interest of generic firms in producing it. Such statin medicines have been
shown to lower low-density lipoprotein cholesterol (LDL) levels, commonly
known as “bad cholesterol,” by 25-30 percent in individuals at high-risk for
heart disease.

Last month, the students from UAEM — with the assistance of medical
librarians from Weill Cornell’s Samuel J. Wood Library & C.V. Starr
Biomedical Information Center — were successful in their efforts to get a
generic version of Zocor included on the list of essential medicines. Now,
the United Nations and other philanthropic foundations can donate large
numbers of the statin drug to the national pharmaceutical inventories of
developing countries.

Furthermore, generic versions of the medicine will be sold at a fraction of
their original price tag. The drug will cost as little as $40 per year per
person—10 cents a day—down from nearly $1,200 a couple of years ago.

The announcement comes on the heels of Cornell University’s new Africa
Initiative, a university-wide movement to promote sub-Saharan African
development and health.
The Weill Cornell chapter of UAEM has hosted an ongoing series of global
health events. On June 15, the former CEO of Merck, Inc., Dr. Roy Vagelos,
will present a lecture titled “Corporations Can and Should Do Social Good”
in a seminar exploring new academic-pharmaceutical alliances to increase
access to medicines worldwide.
Weill Cornell Medical College

Weill Cornell Medical College—located in New York City—is committed to
excellence in research, teaching, patient care and the advancement of the
art and science of medicine. Weill Cornell, which is a principal academic
affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum
that integrates the teaching of basic and clinical sciences, problem-based
learning, office-based preceptorships, and primary care and doctoring
courses. Physicians and scientists of Weill Cornell Medical College are
engaged in cutting-edge research in such areas as stem cells, genetics and
gene therapy, geriatrics, neuroscience, structural biology, cardiovascular
medicine, AIDS, obesity, cancer and psychiatry—and continue to delve ever
deeper into the molecular basis of disease in an effort to unlock the
mysteries behind the human body and the malfunctions that result in serious
medical disorders. Weill Cornell Medical College is the birthplace of many
medical advances—from the development of the Pap test for cervical cancer to
the synthesis of penicillin, the first successful embryo-biopsy pregnancy
and birth in the U.S., and most recently, the world’s first clinical trial
for gene therapy for Parkinson’s disease. Weill Cornell’s Physician
Organization includes 650 clinical faculty, who provide the highest quality
of care to their patients. For more information, visit http://www.med.cornell.edu.

Contact:
Andrew Klein
(212) 821-0560
ank2017@med.cornell.edu

Sandeep Kishore
(917) 733-1973
sunny.kishore@gmail.com

# # #


Sandeep P. Kishore, M.Sc.
Medical Scientist Training Program (MSTP) Fellow
Weill Cornell / The Rockefeller University / Sloan-Kettering Cancer
Institute
Tri-Institutional MD-PhD Program
420 East 70th St, Suite 10M
New York, New York, USA 10021
email: sunny.kishore@gmail.com
tel: (917) 733 -1973
_______________________________

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