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.

Mercury: 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.

PTSD: 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