Saturday, January 31, 2009

wellness weekly

It has been said and I agree, it is easier to stay well than to become well. This is the prevention versus treatment issue that has long existed. The difference now is that so much has been learned about what keeps us well and sadly, we do not do it.

Obesity and Pregnancy: I have talked about smoking and pregnancy as it can lead to birth complications, including low birth weight. I read this week that the same outcome can occur if the mother is obese. Recently I had read that the infant of an obese mother was more likely to have an adverse outcome than the infant of an underweight mother. The low birth weight is concerning because it increases the risk of death in the first years of life.

Breastfeeding and Pregnancy: In this past week I had opportunity to review this issue anew and in fact, wrote to and received feedback from a tobacco researcher, Neal Benowitz, whom I respect much and had not contacted prior to this. I know from a nurse that some hospitals will not allow smoking mothers to breastfeed premature infants (which is another complication related to smoking and pregnancy). I also know that nicotine and carbon monoxide are toxic so I assumed that breastfeeding while a smoker was more than discouraged. It isn’t. And a study also released recently said that many people who smoke do not breastfeed when in fact they should. In other words, the breast milk is better than the toxins are bad. Mothers should wait two hours before breast feeding if they smoke and should always wash their hands and change their clothes before handling the baby. Of course, the best thing to do is quit smoking.

Alzheimer’s Disease: I have seen AD up close and personal with regards to my previous work in a psychiatric in-patient unit, but not in a family member, which I cannot begin to imagine beyond what I have witnessed from watching loved ones of patients I assisted. I believe, and maybe I said this here recently, that environment is the best way to “treat” this illness at this time. Of course, drug companies continue to work to find something to manage the behavior and prevent further memory loss. I was however, somewhat shocked by a headline that I did not write down, regarding the efforts of such companies. Actually, I am going to Google it to see if I can find it, because I don’t think I even need to opine further if you read the actually headline, or blurb that I saw…. Hold Tight… Well I cannot find it but it referred to one of the Big Pharma companies building its “Alzheimer’s Empire.”

Peanut Butter Recall: Well, this just seems like our very own melamine scandal now doesn’t it?

Darvon: All right, the FDA is on this one, at least a panel of experts that they sometimes listen to is. The panel is recommending that Darvon be banned. It is a pain killer that is often abused and or used in suicides. The drug is a narcotic and contains acetaminophen as well. Research shows that the pain relief really comes from the acetaminophen and not the sedating other ingredients. Ironically, the response from one of the two companies that sell the drug was that well, other painkillers are abused too. Well yes they are and even worse, but since it doesn’t really WORK why risk it.

More Play: One can not think that a thing is going to happen and still think that it should and that it is a really good idea. An article this week supports the notion that exercise actually leads to improved learning and that children would benefit from more physical activity and less work. Even if it didn’t, the kids do need to move more as the obesity epidemic is going to rob them of years of healthy life and it doesn’t matter how smart you are if your dead. Sorry teachers! Actually, I know that exercise improves attention, memory and even problem solving skills, anecdotally. This report and those before it find the benefit to kids in as few as one 15 minute break and more benefit with multiple breaks. Some kids don’t get any exercise at home so they have really suffered as recess has been curtailed.

Depression: Just to be fair, though begrudgingly, a study that compared over one hundred studies of our new antidepressant meds found that two were effective based on reduced symptoms and maintenance. In other words, if a drug works but you don’t keep taking it, then it is not the drug for you. We used to say at the hospital, that sometimes the drug that works is the one they’ll take! Because there are so many and so many people switch from one to the other when one works it is hard to tell what really happened. So in this report, Remeron and Effexor may work best, but Zoloft and Lexapro are taken more consistently and thus win the prize. Side effects, though substantial for all psychotropics, were not reviewed in the study. BTW, I recently heard an Abilify commercial that said “if your antidepressant isn’t working” that well you should “ask your doc about ALSO taking Abilify.” I am thinking, if your antidepressant isn’t working… Try something besides a PILL!!!

Happy Weekend oh and go NFC… couldn’t bring myself to say the name as I am and will always be… a NYG fan….


Sunday, January 25, 2009

Wellnes Weekley

Well here a few soundbites then:

Zyprexa: Recall that in the past we have discussed that medication can be used to treat an illness or condition other than one that it was approved for at the doctor's discretion, but the drug company cannot do anything to influence a doctor to use it off label. Eli Lilly just settled a court case for doing just that thing with Zyprexa, though they do not admit to the charge. I know that the antipsychotic WAS pushed for treating dementia and I know many doctors who prescribed it. Recently it was reported that the demented had more heart attacks when taking this drug then matched individuals not on the drug. Drugs are not the answer for agitation in dementia... there are so many environmental things that can be done. The problem is that it takes staff and patience and that takes MONEY. Drugs are easier.

Vitamin Water: It is really just expensive water and cannot be marketed as something healing and health promoting... The Coca Cola company, which I hate to ding, was saying that the drinks were a good alternative to soda and that they could boost the immune system and reduce the risk of chronic disease. One of my favorite consumer groups, CSPI,called them out for these false claims. Further, nutritionists spoke out to say that the sugar content in these drinks contributes to the weight problem in this country. The drinks do appear low calorie until you note serving sizes. I prefer diet soda myself, one a day. But it may be a risky indulgence, I do not encourage you to drink soda at all. The only true safe and non fattening alternative to soda is water.... plain water!

Drastic Gastric: I do believe that having ones stomach made smaller while bypassing the intestine is pretty extreme. I fear, years from now, unanticipated consequences in a group that already has significant post surgery complications. An article this week discussed the case of Senator Bob Clegg who opted for the surgery when the doctor told him his sleep apnea, in his case weight related, was so bad that he would have to have a tracheotomy to breathe. Obesity treatment and obesity consequences, like disability and absenteeism costs over 100B a year. I firmly believe that obesity and tobacco use, the two biggest factors of adverse health are issues that we MUST address in prevention dollars.. it is much harder to get an obese person smaller or a smoker to quit.

Genes are Not the Problem: I have long opined on this issue and like to buttress my argument with research when it allows. This past week a report on a study that lasted over ten years and concerned over 20,000 persons found that knowing that a person had a chromosonal irregularity that increased the risk of heart disease did not change a thing. The chances of heart attack or disease as noted by the genetic testing are no different than the chances of an adverse event from the other risk factors, i.e. high cholesterol, obesity, hypertension, diabetes, family history and c-reactive protein. In other words, if you have any of the above risk factors you MUST take them seriously and modify your lifestyle. Use the gene test money for a gym membership instead!

Happy Weekend, hope it is sunny where you are!

Saturday, January 24, 2009

Wellness Weekly NOTE

Hello ALL

I had to work today and there are two unopened newspapers on my floor... meaning, I am a bit behind in my reading and writing. I did save some things for further review and maybe can get to them tomorrow, but I am not sure... a long run in the morning.. and I need groceries.

I have not forgotten you. Until I have time to write, remember

Don't Smoke, Do exercise and Eat lots of vegetables, many fruits and lean protein. Also, learn something new.. it is good for your brain.

Happy Weekend... we'll catch up soon....

Friday, January 16, 2009

Wellness Weekly

Stents: There has been some buzz lately on whether or not having stents placed to prop open an artery(ies) is as helpful as some surgeons and stent makers would have us believe. This is not the bare metal versus drug eluting stent question, but whether to stent at all and how many stents to place. It appears that stents though helpful in some cases are not the answer to heart disease and do not rule out future heart attacks. Indeed stents themselves can cause complications. Most often the need for a stent is determined through an angiogram. The angiogram is an xray of the arteries after dye has been injected into the patient. Another test for clogged arteries seems to be more prudent in determining the extent of narrowing as not all narrowing is severe enough to warrant the risk of stent placement. Also, medications can help with this problem as can lifestyle factors. I was excited that the new test, which is referred to as a simple blood flow test, resulted in fewer stents being placed and thus fewer adverse outcomes. Unfortunately, what some people call simple still seems invasive to me. The test involves putting a wire in an artery. OUCH> Secondly, the test which is used in the research is another product that someone is trying to make money on. The study was sponsored by the test’s maker, Radi Medical Systems, Inc. There was an eight percent decrease in adverse events on the subjects who had the blood test vs those who had the angiogram and also less stents were placed (by number and by person). This new test costs about 750$ and the angiogram 100$ but the stents costs about 2000$ a piece. Another company is working on a second blood flow test, so that may increase competition and lower price. The invasiveness and the cost are two reasons why prevention is the most cost effective intervention.

: Only adding this today because as I am working on the blog, the topic is on Science Friday on NPR. The conundrum is that the fish is good for us and the mercury in it is bad. If we could get the benefits of eating fish from another source that would be the thing to do, however we can’t. Fish is better than supplements or other sources. At least, at this time you do have the option of which fish to eat both in species and location. Also, there is renewed effort in the legislature of getting the Clean Air, Clean Skies programs funded and enforced so that there are less mercury emissions, esp. from coal fired power plants. Recall also: the bigger the fish the more the mercury. In RE fish oil supplements, this was addressed by Dr. Cohen on the show and he said, a few studies on these supplements with pregnant women did show improved neural development in their children. Dr. Cohen did also noted that eating fish may keep you from eating something less healthy, like red meat, and that is also important. It really is a complex issue. (there was discussion about having your mercury levels tested on a routine basis by blood or hair analysis. The goal is less than 5 micrograms per liter). OMG the commentator then talked about grocery stores getting in on this and marketing lower mercury fish. So what about the label I made back in 2005… it would be perfect! See the Good Fish Bad Fish link on the left for more on that.

Drug Risks: It may have been as recently as last week that I noted that antipsychotic drugs produced significant side effects. This week a report was released on a 15 year research project that tracked about 90,000 persons who were on either an older antipsychotic, like Haldol, or a newer one, such as Zyprexa or Risperdal. There was a third group as well. A group of over 100,000 persons who were similar to the 90,000 persons but who did not take these meds. The finding is that old or new, the antipsychotic medications doubled the risk of cardiac death. There are some people for whom life is greatly improved by the use of these medications. This is a little different than heart disease, as bipolar disorder and schizophrenia are more often if not always, gene related and not a matter of life style, so far as we know just now. The upshot is simple, the drugs do not work without significant risk. And my concern is starting children on these medications…. It just shouldn’t happen.

: There was a heck of a lot of press this week following the crash of the US Air plane into the Hudson River. Much of the coverage was respectful, some was sensational and a little was asinine. I was most concerned by one of the cable channels interview of a mental health professional (not sure if it was psychiatrist, psychologist or mental health counselor) none the less, the person was talking about how the persons who experienced this trauma might be thankful now and have a bit of bravado, etc, but in time this is really going to hit them. And she pretty much let them know that they would be suffering from post traumatic stress disorder in the near future. You know what, maybe they won’t. Maybe they will get support from friends and family, process the events of the day and actually rebound quite well thank you very much. We do not need to tell people that they are going to be impaired instead we should EXPECT that they won’t be and be ready to help them if we are wrong.

Medical Devices:
The FDA is responsible for testing and reviewing medical devices. Medical devices come in different categories, for example, bandages and glasses, vs. breast implants, vs. stents, vs. pace makers etc. The companies who want to market these are supposed to provide the FDA with evidence that the device is not only safe but also that it is effective, similar to what we expect of new drugs. A report from the GAO that caught the eye of the consumer group Public Citizen notes that the scrutiny has been lax for many years. They noted that there has been a specific failure in vetting as many as 24 devices and Public Citizen feels that this has put “tens of thousands of Americans at risk.” A letter has been written to the Obama team regarding this matter and the FDA is aware of its need to improve, though they have not presented any method for doing so.

That’s all.. Happy Weekend

Sunday, January 11, 2009

Wellness Weekly

Well this week’s entry is going to be a bit of a challenge and I think I will just stick to narrative form for the sake of expediency. You see, the NY Giants are in their play off game at this moment as I sit awaiting my service call from Comcast. Thus if I do get this written there is a good chance I cannot post it anyway. Takes some of the fun out of the work, I’d say.

But we will start with Eli Manning and the NFL. There is a campaign underway by the organization to encourage physical activity in children. I believe it might be called the Movement for an Active Generation. Another commercial that is running has to do with keeping gym (Jim) in school.

Just yesterday I saw that the CDC has come out with a revision on our obesity and overweight numbers and it appears that the obese category is now higher than the overweight. With both over 30%, it is safe to say we have an epidemic and we have a problem. There is more of a problem here that can be handled by medications meant to treat chronic disease. This is the time for prevention.

I have read in several different publications recently that indeed health care reform may involve more of an effort to get us moving more and eating less. It is always the same. Don’t smoke, be active, maintain a normal weight and eat plenty of fruits and vegetables.

A new term has come out this week to coin an old problem. The folks at Mass General have decided that the chemical residue from cigarette smoke may be taken more seriously if it is called third hand smoke. It isn’t smoke, it is residue from smoke, but whatever you call it, it can be harmful and will be the fodder for additional anti tobacco policy.

On CNN House Calls this weekend there was a tobacco cessation specialist who took calls on quitting smoking. I was encouraged that nothing he said contradicted anything I say to my own clients. I did note that he said that there is NO QUESTION on whether or not smoking causes lung cancer. The fact that a very small minority of smokers do not get the disease and an equally small number who never smoked do, does not change this scientific conclusion. Further more, tobacco is responsible for 30% of cancer cases.

I am encouraged also that the topic of overmedication and medication with risk is being addressed more often and more openly. In fact, one of the most outspoken and cautious physicians, Dr. Sidney Wolfe has joined the FDA. Though Dr. Wolfe does not deny that certain medications have been instrumental in increasing longevity and quality of life, more of them do not.

Lastly, antipsychotic medications that are sometimes used to treat agitation in the elderly who have dementia have been associated with increased risk of death in those patients. As I have said before, psychotropics have some of the highest incidence of side effects and the use of them in vulnerable populations, like the old and the young, should be questioned.

Have a Good Week

Friday, January 2, 2009

wellness weekly

Calories in a Bottle: An article written by the director of Bay County Health Department bemoans the incidence of overweight and obesity in this country and the author opines on the irony of how sports drinks exacerbate this issue. Of course, I read with commiseration. He pondered the likely hood of being able to sell water with sugar and salt in it to people who were overweight and perhaps trying to lose weight. He made good points about schools that removed soda and added Gatorade. He noted how a 200 pound man mowing his lawn hydrated with a 200 calorie drink. He even went so far as to question the parents of little soccer stars who came to games with half time snacks and after game meals AND sports drinks. He thought that the child might have been better off at home watching TV. I haven’t made exactly the same correlations as he, but I do believe that sports drinks, low calorie ones at that, are meant for people who are in vigorous activity for an hour or more. I also strongly endorse the Elete Electrolyte drink which has no calories at all. Oh yes, and then there is this stuff called water.
Pharmaceutical Cliffs: It may benefit me to stop reading the Wall St Journal as it presents health information from the view of companies that create drugs and the stockholders who want that drug to be profitable. No, I love the WSJ. It does put things in a new and uncomfortable light sometimes. Take this example. This week the journal reported on Norvatis’ concern that their billion dollar blockbuster hypertension pill, Diovan will soon be coming off patent. That means that people who need to take this medication will be able to take a generic form at a much reduced price. This is good news for the consumer, bad news for the company. They also do no have a newer blood pressure pill ready to take its place. That is what companies try to do as they switch the patient to that new drug before the patent expires on the other. Because this is not an option for them now and because the FDA is making it harder to introduce new drugs, the company is heading for a “cliff”. Has creating a medication to treat an illness ever NOT been about making money? To me, the best way to combat the high price of prescription drugs is to not need them at all. I know that is not always possible, but it is a helluva a lot more possible than people think. PREVENTION is no mystery.
Genes, Supplements and Cancer: Without repeating the stories and headlines that I have seen on these issues this week, I will just report the outcome. Scientists are telling us that based on the research to date, supplements do not protect against cancer the way that foods with antioxidant properties do. Thus I will say to you again, taking fruit and vegetable PILLS, (they really make them) will not reduce your baseline risk of cancer. Nutritious meals may. Further, it was said this week that the research into genes that are linked to certain cancers (and illness) is sketchy at best and very new at the least. At this time, ones lifestyle has a much greater impact on whether or not chronic disease will develop. It may be a broken record at this point, but this could be the day that someone decides to listen so I will say it again none the less, do some physical activity that increases your heart rate, every day. Eat in moderation. Eat foods that are low in fat and limited in processing. Keep sugar intake at very low levels. Consume lean proteins and plenty of fruits and more vegetables. Watch for starchy produce and do not eat with such abandon. Ie , more spinach than potato and more apples than pineapples or banana. Remember too that low fat, low sugar, and 0 TFA does not mean low calorie. You still need to look at the labels.
Charles Grassley: On CNN, Anderson Cooper often talks about “Keeping them Honest.” I like to think that this Senator is doing just that as he calls for scrutiny of drug companies.
Second Hand Smoke: It is my assertion from research that second hand smoke does nearly everything adverse to a person that first hand smoke does. Both active and passive smoke causes lung cancer by scientific fact though the dose and frequency are influential. In other words, a person would need to breathe more second hand smoke for more years to have the same risk of lung cancer as the smoker. Cigarette smoking has also been causally linked to heart disease and heart attack. Once again, a city that has put a public smoking ban in place reports a lower incidence of emergency room visits for heart attack by NON smokers. What is interesting in this new study is that they didn’t just compare their own admissions but that of the hospitals in surrounding cities that did NOT have a ban. The finding stands. Second Hand Smoke kills and banning smoking in public is an effective public health strategy. As I like to say, there is no amount of cigarette smoke, in any form, that is safe.
.Scientists in the Hot Seat: Just briefly. In the past I talked about a company that was trying to make a pill that would have the effect of resveratrol in controlling the aging process. I think that this is a snake oil and was most upset when the company referred to diabetes as a disease of aging and said that their pill could extend healthy life years. One company working on this , Shaklee and another GSK (Sirtris) have been using a doctor from Harvard as a spokesman for this product and have paid him millions of dollars. This doctor is now resigning from their board. Another doctor is being questioned about his endorsement of Risperdal, an antipsychotic medication, in children. There is NO reason that I can fathom for starting a child on a class of medication with so many unpleasant and life threatening side effects. I am happy to see that these types of conflicts are making it to press and I also think that the aforementioned Senator will see to it that this continues.

New Year is Here…. Get out and PLAY