Monday, November 30, 2009
Lipitor is a cholesterol (LDL or low density lipoprotein) lowering drug. There are several drugs in this class (statins) that are available. Lipitor has been the most aggressively marketing and promoted, now the most expensive and the most profitable. It is due to come off its patent in 2011. It is considered a block buster mega drug for Pfizer. I have always considered it with disdain and by default, all of the cholesterol lowering drugs.
In reading the FT article by Andrew Jack I did develop a new respect for the medications which were created from research beginning in the 1950s, in Japan, by scientist Akira Endo. Dr. Endo studied the properties of thousands of fungi, in an effort to produce the medicine naturally, much in the same way that penicillin was created. I was somewhat startled to read that in the late 1960s, Endo expressed concern about the lifestyle habits of baby boomers and that they were suffering heart attacks at high rates and young ages and at the same time had high cholesterol. He began to think that the cholesterol levels should be lowered and he worked for years to find a medicine to do that.
A number statins were developed/created and are indeed available for use. Several companies and several scientists contributed to this. It was interesting also to read about medications that failed in trials, that killed animals, that were too similar to other drugs and to know that the FDA was actually on the ball in this regard.
It was funny to read about the first statin that came out, as it was a very gritty powder that was mixed with water and drank. Someone likened it to drinking sand. I think that was Mevacor. Whatever the name, my father took it. I well remember his little containers where he shook it up and drank it and the round can that it came in.
Still the lowering of high cholesterol was a grand thing, but the important thing was reducing the number of heart attacks and doing so with the least side effects. Lipitor pretty much won that contest and when the original company, Warner Lambert, partnered with Pfizer, the marketing campaign began. This was 1997. (My dad died of a heart attack in 2002)
The end of the 90s was indeed the time that the drug companies went crazy with direct to consumer marketing, but before that, they were aggressively pushing medications to doctors and nurses, residents and interns in both private practice, health clinics and hospitals. Having worked in the medical field during the early 00s, I can promise you this, the wining and dining was extensive and elaborate. My mother, in the restaurant industry, can tell you the same thing. (You might also recall that Pfizer has been sued several times and has had settlement judgments because of this marketing - among other things)
Lipitor was originally less expensive then the other drugs, but the sheer numbers of prescriptions made it the billion dollar drug that it still is. Pfizer fought a good hard fight to get the drug patent extended. Ways to do this include changing pills to extended release, or once a week from daily, that sort of thing. Pfizer was working to combine this LDL lowering drug with an HDL enhancing one, but the clinical trials were halted due to adverse health effects (death).
Pfizer, in my opinion, has not taken any of the law suits seriously, but they have cut back on staff and made other changes as they accept that the patent is not going to be extended and they are going to lose money. They also note that governments and insurance companies are (GASP) asking for more rigorous clinical trials and proof of efficacy and safety. In fact, these primary care drugs are not going to be profitable anymore, instead companies look for speciality drugs and I expect cancer drugs are where the real money is.
Pfizer is still being aggressive in commercials. Nearly ever day I hear the one about how generic statins are out there, but there is no generic Lipitor. So, the commercial says, if your doctor switches you to a less expensive generic it is NOT the same medicine you have been taking. And of course, based on the earlier research, Lipitor was superior to the other statins, but even that has been challenged of late.
From reading the article, I come away with more respect for statins, ones that lower cholesterol AND reduce heart attacks, but even less respect for Pfizer because of the ads I hear on my radio today. And I absolutely hunger for comparative research so that I can look at the statin meds side by side and compare the efficacy and the side effects of each. (there are websites that allow me to do this, but it's work!)
I am worried about the lack of prevention that has occurred since the concern of heart disease and heart disease deaths related to diet and tobacco were raised over 50 years ago. The baby boomers may have started this, but it is their grandchildren who are the obese who will be suffering these primary care illnesses at far too young of an age and who will likely experience the first decrease in life expectancy compared to the generations preceding them.
Sunday, November 29, 2009
The Impact of Pictures: My family is busy these days so maybe this blog post will escape their attention. I always think about that because they know me in ways that the general reader does not. It is good that my readers do not know everything but today I will tell you a little something. It is not so earth shattering. I have said before that I was once, for a significant period of time (5 plus years), quite overweight, even my family has forgotten how much overweight I was. Over the holiday I got my hands on some old photos and well.. ouch. And it isn't that I have forgotten, because I never will, but seeing the pictures breathes life into the fears I have of being that girl again. It was not a happy time and in that I can tell you, "food does not make you happy." Unfortunately (?), the fear of the past makes me extremely disciplined and that upsets people, like my Mum, much more than it upsets me. I would rather skip all the extras (food wise) and be comfortable in my own skin. It keeps me content. That being said, my rigidity is mine, I own it and I do NOT encourage it. At the same time, it is worth emphasizing that my extremism does not excuse you from doing your own due diligence. We have to do what works for us, and being overweight is not going to "work" for anyone.
Excesses: In America, we have just finished the Thanksgiving Holiday. People make a whole lot of food to celebrate a time we do not remember. What we are really doing is giving thanks for blessings and abundance, which, in my personal sphere, is possible. I hope that everyone enjoyed the day and then moved on - back to the routine of moderation. There are some who have difficulty moderating. A friend told me today that she quickly clears the home of all the extras - pies, stuffings, heavily sweetened or buttered casseroles and such. I think that is a good idea, of course, she does her best not to make too much to begin with, but in the end, it is better to toss it then to wear it.
Toys v Candy: This story is true. This story only got more interesting as it went along. This is something I observed today and as it was happening, my blogster mind was at work. I was in line at the grocery store, where I must say, I am most often aghast. Today I was behind what appeared to be a three generation trio of women. The youngest of these was approx. two years old. The grandma, not old at all, possibly 50, gave the child a plastic "magic" cell phone that was on a rack near the register. I noticed her reaching for the phone, I saw the price on the shelf, about three dollars, and I thought WHOA that is too much money, BUT it is so much better than giving the kid candy which is what so many others do. That little girl, she was so happy! She chatted and laughed and her eyes were all lit up. I had to smile myself. And when they were all paid up and about to leave, I thought I heard the woman I assume to be the grandma, say "I'll get you another one." But she didn't, she TOOK IT AWAY and put it back where she had gotten it from - they left the store with the previously happy and content toddler squalling at the top of her lungs. Oh MY, I was just stunned - cruel I thought it was, but that is a harsh word. A few hours later though, I thought OMG - they put that phone BACK on the shelf!!!! What if your kid puts it next to his or her MOUTH next.... ? SIGH... I really need to stop shopping, it causes me stress.
WLS: I wouldn't even know that acronym if it weren't for my dear dear friend who had Weight Loss Surgery. She knows, and regular readers know, I OPPOSE it, it seems crazy and reckless and extreme and scary and well, I have run out of words, but I don't like it. At the same time, I want my friend and others who suffer with severe obesity to lose weight and regain their health, so I support her and those like her, 100%. Today, however, I heard a commercial on the radio that got my dander up. First a woman spoke, she spoke about being very much overweight and thinking every day when she woke up that she wouldn't eat (mistake) or she would eat less, but at the end of every day, she had failed. Then the man says that he is so big his son has asked him to stop taking him to school. Now I have to say, the man sounded like an actor and the woman sounded a little more legit. Then the commercial went on to promote weight loss surgery and it irked me. If a person truly needs this type of extreme, invasive, risky intervention, then let the person's primary care physician make that call... it isn't like the person is choosing a household product, it is a life changing, extreme medical intervention...
and that is the end of the odds and ends..... remember - you cannot indulge every day without paying the consequences - so Thanksgiving is OVER people... :)
Saturday, November 28, 2009
Friday, November 27, 2009
I bring this up today because just as the nutrition guidelines are supported with a food guide pyramid, so are the physical activity recommendations. In this case, the University of Missouri Extension has created a pyramid that is available to download for free. This pyramid is pretty easy to follow and I thought that you might enjoy taking a look.
Remember cutting calories can reduce your weight while physical activity and exercise can improve your heart and lung function and prevent some disease.
Wednesday, November 25, 2009
What I find fascinating is that the hormone pills, though found to be a causal factor in breast cancer, are still FDA approved for use in treating menopausal symptoms. What has changed since the Women's Health Initiative study uncovered the link, is the label. The label on the product now cautions that the pills should be used at the lowest dose for the shortest amount of time.
Women who are involved in the lawsuits used HRT for years, as was once the standard of care. The lawsuits are often twofold. There is compensation claims and there is punitive damages. Some lawyers are alleging that the companies, Wyeth and Pharmacia, knew the risks before the federal government stepped in and they tried to down play them.
Pfizer contends that the handful of cases that they have lost will be overturned on appeal because they are not doing anything wrong. One point they make is that the drug is STILL FDA approved for use. Now how can you argue with that and WHY is that?
Tuesday, November 24, 2009
Okay I have my notes in my lap and thoughts in my head, so let me share a couple (okay some) things about smokeless tobacco, or ST. The majority of the information that I am sharing today was learned from both a National Smokeless Tobacco Conference and an accredited Smokeless Tobacco training produced by the Mayo Clinic. I am however, explaining this in my own words and based on my comprehension of the material. I believe the following six things are the most important.
1) There are different types of Smokeless Tobacco (ST). Depending not only on where you are in a country, but which country you are in, there are differences. The following types may be the most common.
a. Chew Tobacco: This is cut leaf tobacco that comes loose, in a twist or a plug. This is usually chewed briefly and then placed between the cheek and gums. This type is used more in the USA than other countries but is not the most common ST in the USA. The most common brand is Redman. This is considered a spit tobacco. Some hard core addicts will swallow some or all of the juice. Many people who use this will say they are going to have a chew or a chaw.
b. Snuff: This is ground tobacco and it is the most common type used in the USA. The most popular brands are Copenhagen and Skoal. Snuff can come dry but most often it is moist and is either loose or in a pouch, like a tea bag, but a small rectangle. It also produces spit. It too is placed between cheek and gum, but more often towards the front of the jaw then the side of mouth. Many people refer to this as a dip. It does produce juice that is not intended to be swallowed.
c. Snus: this tobacco is even more finely ground than snuff, but it is more common in Sweden. Snus is often placed between the upper lip and gum. It produces less saliva and is not considered a spit tobacco. It is now being manufactured by Philip Morris and Reynolds American or companies that they recently purchased. Traditional Swedish snus is produced quite differently than American snuff.
d. Betel Quid: This is a tobacco blend and it is common in India. I do not know a great deal about it and do not think many people in the USA use it.
2) The health effects of ST use are not as uniform as those from cigarette smoking. For instance, the betel quid is linked to several more diseases and adverse outcomes, including cancers, than the other three products. All ST has intra oral effects and extra oral effects. There is a causal relationship between chew tobacco and snuff and oral cancer as well as gum recession, gum disease, pre cancerous lesions called leukoplakia and tooth loss. Snus is also associated with the oral diseases, but not cancer (in Sweden). The extra oral effects of chew and snuff include pancreatic cancer, an association to reproductive problems and an association of increased risk of death from existing heart disease than found in non users with heart disease. Nicotine in all the products increases heart rate, blood pressure and pulse. It is important to note that the reason scientists think that snus from Sweden is less harmful than American snuff is because of how it is made. Snuff is fire cured, fermented, packaged and shelved for sale. Snus is air cured, steamed (sterilized), packaged and refrigerated.
3) There is a variation in the nicotine content of ST and the manufacturers are responsible for some of that difference. There is some evidence to support that tobacco companies aim to have people start with lower nicotine products and gradually move up to higher ones as they build up tolerance. Using higher nicotine products can lead to addiction and addiction leads to difficulty quitting, which means the tobacco companies can continue to make money. There is generally more nicotine in the finer cuts. There are also additives. Ammonium Bicarbonate increases the amount that the user absorbs from the chew or dip and acetic acid increases salivation which also increases the amount of nicotine absorbed.
4) Quitting ST is somewhat different from quitting smoking and these methods may be helpful to current users.
a. Blending involves the use of an herbal ST substitute. You begin by taking the pouch or can and making it half and half (tobacco and herbal product), after two weeks you make it two thirds substitute and one third tobacco and use for three weeks and then you go to all substitute and quit.
b. Brand Switching refers to changing to a brand with less nicotine than you currently use, so going from Copenhagen to Skoal.
c. Fading involves the number of dips or chews that a person normally takes and fading them out. You reduce the amount by one or two per day until you get to the half way point. For example, if you do ten dip/chews a day, when you are down to five, you quit.
5) The quit smoking medications that are FDA approved for use and recommended by the PHS Clinical Practice Guidelines are not also recommended for ST cessation, but let me tell you more about that. At this time they are not recommended because they did not meet the criteria of adequately increasing quit rates. In the tobacco field this is often referred to as cessation. So ST users did not have better cessation rates on the Nicotine Replacement Therapy (NRT) than the placebo group did. However, the medications DO reduce withdrawal complications and cravings. One theory is that the ST users need much higher doses of NRT than smokers do. In research and at the Mayo Clinic they do use the non NRT medication Zyban and the also use the patch and the lozenge. They base the patch dose on cans or pouches per week. Remember, it is almost 75% or more likely to be cans or snuff than chew tobacco. Less than two cans per week users get a 14 mg patch to start, 2-3 cans per week users get a 21mg patch and greater than three cans per week users gets a 21mg patch. This is all off label use so talk to a physician or tobacco treatment specialist before dosing yourself.
6) The motivators for quitting ST often include health consequences, social pressures, rebuking the addiction and the cost. Here is some math on the cost of using and the amount that could be saved in quitting. In my area of the country, South East USA, a can or pouch of tobacco costs between 5 and 7 dollars per. The user first needs to know how many they use a week. For example 3 cans per week: 3 (cans) x 4 (weeks) x 12 (months) = 144 (cans per year) 144 x 6 (dollars) = 864 dollars spent per year. Now if that person quit tobacco for five years, they could save over 4000 dollars!
And that my friends is the end of my smokeless tobacco blog post............. whew
Monday, November 23, 2009
So for plan B, I want to share something that I heard this afternoon. I believe it was the show Talk of the Nation that I was listening to on NPR. An author of a book possibly titled, Rationing Health Care, was the guest. There were also callers who gave opinions and asked questions. In the course of the show then, I learned this interesting bit of fact:
Numbers crunchers are not really worried about the effect that tobacco users, namely smokers, are going to have on health care. This was brought up when a caller asked about people having to take responsibility for health outcomes (and their treatment) that were largely caused by their own actions. (In other words, not genes or environment, but things like smoking and obesity)
The guest said that smokers tend to get lung cancer in their sixties and die relatively quickly so a lot of money is NOT spent on treatment. At the same time, the smokers have paid into Medicare through payroll taxes and the Medicare dollars can be spent on someone else AND because the smoker is now dead the Social Security income they would have received can stay in the system.
Obesity, on the other hand, tends to affect people at younger ages and does lead to chronic conditions that are very costly to treat over time.
What we really need is an over haul of prevention and a way to make taking good care of ourselves in the first place a cost effective and attractive thing to do. But for once, smokers do not have to feel like everyone is picking on them.
Sunday, November 22, 2009
Let's start then with what she sent me:
Pop the Pig: I am not a parent and may have missed this if not for someone sending it to me. It was an advertisement for an actual toy. I cannot believe this isn't an SNL skit. Nope, instead of Kerplunk, which is what I played, we have Pop the Pig. Children take turns, maybe by rolling the dice, to put little plastic cheeseburgers or burgers into a pigs mouth until eventually, someone will put the one burger in that POPS the pig. OMG, you just cannot be serious>>>>>
FEASTING: Again, I didn't find this on my own, but my friend did while watching Mary Poppins. I assure you, I watched the musical when I was young. In the show there is a line that is VERY relevant not just for this Thursday but for ANY day and it is, "Sometimes enough IS a feast." Amen sister. Let me add, sometimes the conversation is the feast!
Sesame Street: Well, I could be wrong, but I think it was from SS. They have little skits about healthy eating, drinking and exercise, so there is hope. The skits are by the Organ Wise Guys.
Meridia: Another FDA alert reached my mailbox in the last two days. This warns of some adverse cardiovascular outcomes with the weight loss drug Meridia. Let me copy the message right in the text:
FDA notified healthcare professionals and patients that it is reviewing preliminary data from a recent study suggesting that patients using sibutramine have a higher number of cardiovascular events (heart attack, stroke, resuscitated cardiac arrest, or death) than patients using a placebo (sugar pill). Sibutramine is marketed as Meridia, a prescription drug, in the United States. Meridia was approved by FDA in 1997 for the management of obesity, including weight loss and maintenance of weight loss, in conjunction with a reduced calorie diet. Meridia is only recommended for obese patients with an initial body mass index (BMI) ≥ 30 kg/m2, or BMI ≥ 27 kg/m2 with other risk factors (e.g., diabetes, high cholesterol, controlled high blood pressure).The analysis of these data is ongoing and FDA is making no conclusions about the preliminary findings at this time. These findings highlight the importance of avoiding the use of sibutramine in patients with a history of coronary artery disease (heart disease), congestive heart failure (CHF), arrhythmias, or stroke, as recommended in the current sibutramine labeling.
Smoking and Weight Control: The above blurb reminded me of something else that occured to me this week. A report was released with the most recent rates of obesity per state. I noticed that the states with the highest rates of obesity, West Virginia, Kentucky and Tennessee - were ALSO the states with the highest smoking prevelance. Which begs the question or challenge- "If smoking keeps you thin, why are the states with the most smokers the fattest?" And the answer is .....Because - food makes you fat or thin - PERIOD>
Testing: This week recommendations regarding mammograms and Pap smears were released and the former still has everyone in an uproar and the latter, less so. Now the politicians are getting involved. You know, we have to do this research and we have to let people tell us the results without fear of being blackballed over it.
Nails: One of few indulgences that I allow myself, and only in the last two years, is an eyebrow wax. [i am Italian and unibrows are NOT attractive]. I never have my nails done, no mannis and peddis for me... I do not always go to the same shop, but the women seem to all be Asian and often Vietnamese. I went today. The young girl exclaimed that she remembered me. I was the one that liked to exercise (once I went there after a run at the beach). She gave me lots of compliments about looking young and healthy, etc. She said not everybody was like that. I knew what she meant, though she did struggle finding her words. I summed it up for her with this observation, "Some people care more about their nails then their bodies."
I may not post on Thanksgiving - but I will try to keep it up till then. Be mindful to exercise and eat right before AND after your holiday - it is just a day.... all bets should not be off because of it.
Saturday, November 21, 2009
Kruskall L. Caffeine and Exercise Performance.
ACSM Health and Fitness Journal. 2009. vol 13, no. 6
The most important thing to say is that there is more evidence to support the assertion that caffeine enhances performance than there is to say that stretching does! Caffeine is considered a drug by some and has had some naysayers, but there is certainly a safe and effective dose of caffeine, just as there is of alcohol. Caffeine occurs naturally and is also synthesized. It is found in plants, foods and other products. Like alcohol, some amount of caffeine can actually be health promoting. Though there is evidence to support an association between caffeine consumption and some disease prevention, the article I read today was not about that.
Many people are interested in the research about caffeine and physical performance, caloric expenditure and fat burning. I can tell you that there IS research to support an increase in performance, but not of calorie burn or metabolism and not of fat burn. Where science does show some changes in metabolism with caffeine, it is in certain teas which have caffeine along with a substance commonly known as EGCG. [bottom line here is that you will be wasting your money if you buy products claiming to boost your metabolism or fat burning potential]
And though I said that there is a safe and even beneficial dose of caffeine, there is also a level which decreases performance and makes us feel not so good. Without getting into the science of it all, it is true that caffeine is an ergogenic aid, if nothing else. This means that it helps us to increase both our physical and mental labor or output. It may do this by helping us to focus, reducing fatigue and making it feel like we are not working as hard as we really are. A few system responses are responsible for this. Caffeine can stimulate the central nervous system, which includes our brain and it inhibits a neurotransmitter that makes us feel tired. It may also affect our muscular contractions.
People who use caffeine on a regular basis do have some tolerance and might need more caffeine to boost their performance than people who use it just before an event. However, it is important that one start using caffeine in their training, and not wait to the event date.
I noted the following advice as particularly important for anyone. If you are going to get off caffeine you should taper yourself off because stopping abruptly can have a negative impact on performance and can generally make you feel crappy.
Caffeine helps with endurance and anaerobic ( very hard - intense- breathless) activity and though it may help with resistance training, because it can increase heart rate and blood pressure, I do NOT recommend caffeine boosting before lifting. (caffeine is not associated with heart attack, that has been disproved over time)
There is a threshold as I've said. It might be wise to stay in the range that the research found helpful and that is about 5 to 6 mg of caffeine per kilogram of body weight. You can determine your kilogram weight with this calculator... and then multiply that by five. You can look up caffeine contents on line, not all products actually list them. Even an 8 oz cup of coffee can vary in content from 65-135 mg so you won't have more than an estimate.
Again, caffeine does not help you to increase your metabolism or burn fat, but it may help you to run, swim and cycle better or more comfortably. Personally, oh YES<>
Friday, November 20, 2009
Hold the Stuffing is a contest that is played in some form or another at many businesses at this time of year. The point of the "challenge" is to support people who have made strides in obtaining a healthy weight, even if they are not at their goal weight yet. Health Promotions staff encourage people to just keep things even and enjoy the holidays.
This means that the person is not to try to lose weight over the next six or seven weeks, but it ALSO means that they are not to gain any either. The threshold is 2 pounds. The "contestants" cannot go up OR down more than two pounds from their start weight. The weight needs to be taken before Thursday November 26th.
You can play with teams and go by a group weight or you can do it individually. We are doing it individually at my small office and I created a tracking tool for each person to use. I will link it here and you will be able to play too if you like. Just print the form, get your weight and be mindful of your eating.
That being said and Thanksgiving a mere few days away - let me share some things my sister has learned from her Weight Watchers class. (everyone knows that if they tell me something they risk seeing it in a future blog post)
One thing that the program has its members do is think of all the things they would like to eat on the day and to portion them out on a paper plate. Actually take a plate and write in the things you are going to eat. Hopefully, you will make the lower calorie items take up more space than the high calorie ones. My sister shared something else which I REALLY like and that I include on the tracking sheet. That is to "control what you eat, how much you eat and when you eat." I have been doing this for years and years and I highly recommend it.
Do taste lots of things on your holiday, just don't eat so much of them! Also, be careful because some items have more calories than you can possibly imagine!
Thursday, November 19, 2009
I received the FDA alert and also read the company's press release. Then I went to the company website and that is where my mind sort of boggled. Okay, I can't even peruse the website without feeling stupefied. They advertise it as (a trademarked) "Sexticement", it works in 30 minutes and lasts 72 hours. It is a blend of several different herbals and is sold as a supplement. NO where on the website did I see mention of the recall. That is odd because in their own press release they talk about how serious they take that sort of thing and how they use an independent laboratory that is supposed to increase safety and purity. They blame the taint on one of their raw ingredients that came from China. Oh yeah, it has to be China's fault, I bet ALL the ingredients come from China and it is probably bottled there too!
Anyways, the FDA reports that tests found an undeclared ingredient in the product and though the FDA doesn't regulate supplements it can take action if they are not what they say they are. In this case, the unidentified ingredient is a derivative of Sildenfil aka Cialis.
Men with certain conditions can experience extremely low blood pressure and that is why the Cialis commercials have a disclaimer. The FDA alert didn't say as much as the Rock Hard Laboratories press release did. In the press release it is said that men with certain conditions often take medication that lowers their blood pressure and can thus have fatally low blood pressure if taking ED (erectile dysfunction) drugs. Rock Hard Weekend is not supposed to be a drug. Anyways, the press release goes on to say that men with the following conditions often find themselves sexually compromised - high cholesterol, diabetes, high blood pressure and heart disease.
We might not be able to help the 60 plus year old men, but it is time to tell the teens - eat right and exercise, your penis will thank you later!
As for the Rock Hard Weekend, well you can get your money back - learn more from the FDA website.
Wednesday, November 18, 2009
He spoke for over an hour, but the points that resonated with me and stayed with me, were these two. The first is that for something to change everyone has to see that there is a problem. Those same people have to see that there is a solution(s) to that problem and then there has to be a window of opportunity to address it. We have all three right now he said, but that last one, it is going to change as politicians start to worry about other things, like elections. Unfortunately, we will still have a problem even if they stop talking about.
The second issue that made sense to me is that we have great expectations and demands in this country and they are VERY expensive. We do not have the resources to maintain this level of health care but it is also very unlikely that we will change our way of thinking about this. For that reason, rationing may HAVE to take place. ( He didn't say that part)
He is referring to the idea that we need to have the most expensive drug or the newest drug even if it doesn't work better than the older drug. We want CTs and MRIs and PET scans even when the results won't change the treatment course. We want medical devices and other diagnostic tests and we want pills for everything. When we talk about comparative research the public, often stirred up by politicians, thinks it means that people will not get choices and the government is going to take away the better treatments. Comparative research is really the opposite of that. You have a right to know that the brand name drug ISN'T better sometimes. Or that yes, taking one pill a day may be easier than taking two, but if the long acting pill is quadruple the cost and no more effective, then we really can't afford that pill merely for convenience.
A perfect example is the research out this week that says women may be able to wait ten years (to age 50) before starting mammogram tests and then only need them every other year. Doctors, organizations, people in general are all aghast at this and before ANYONE said a word about the report, I thought, okay well, that makes sense. If the testing isn't changing the outcome then why are we doing it? And for everyone to scream about it now is just nuts. Yes, we always did it before, but maybe we don't have to now. I, for one, as a woman, was thinking, OH THANK YOU boob god... however, I may not get the reprieve some get because of my family history, darn it!
We do research to find out what is best for us. What prevents disease, like use of condoms, and vaccines - what prevents conditions from becoming diseases, like pap smears, PSA tests (sometimes) and blood work. What keeps a disease from killing us, like some medications, chemotherapy and surgery. We should then apply the research and if someone disproves it, then we have to act on that too. Really, is anyone griping because we don't do blood letting or leeching anymore?
Lastly, sometimes the treatment doesn't cost a thing, but you have to do it. Perhaps you have pain from arthritis or some form of insomnia and the recommendation for both is to increase physical activity or lose weight or lift weights. Maybe the person with a sleep disorder has to commit to a routine. Perhaps to prevent cancer the person has to stop smoking or tanning or drinking too much. Too hard you say, doc you say, just give me that pill I heard about on TV... well, if we keep it up, there will be no medicine and no doctors to dispense it. Which is another point. Specialists. We have too many specialists, ordering too many tests and doing too little communication with each other. Again, $$$$$$$$$$$$$$$$$$$$$
Um, so , yeah. Lost my train of thought really, guess this turned into a rant. Okay, then... have a good night/day. :)
Tuesday, November 17, 2009
The November 13 MMWR (Morbidity and Mortality Weekly Report – morbidity means disease) from the CDC (Centers for Disease Control) , of which there were two, give us different numbers in regards to tobacco use and cessation (quitting). This is confusing. One report uses the in person NHIS (National Health Information Survey) data with 62 % of 21,781 persons responding and the other is from the BRFSS (Behavior Risk Factor Surveillance System) telephone survey of 414,509 respondents. (notice the HUGE difference in numbers and that one is an in person survey and the other a telephone survey)
It is said that the findings are different as the NHIS data is meant to track trends towards the Healthy People 2010 objective of 12 % smoking rates, while the BRFSS gives us better state level measures.
That being said, Florida’s smoking prevalence rate HAS declined. (newspaper headlines are focusing on the first national prevalence increase in I believe 15 years. I do not want me or you to be disheartened because we ARE making a difference in Florida. ) According then, to the MMRW that focuses on state – level estimates, Florida is now at 17.5 % total adult smokers, 18.7 men and 16.4 women! That is BELOW the national average with which we were even last time.
In the MMWR with the NHIS data, we learn that the highest level of smoking is in persons who have a GED. Interestingly, in the data set, I see that all age groups have gone up in prevalence EXCEPT the 18-24 age group. Otherwise the age group prevalence was similar across the board until we get to age 65 which is significantly lower (death and quitting!) Also in this data set: of all persons who had smoked at least 100 cigarettes in their lifetime, 51% had quit.
And for tobacco treatment specialists and educators, this statement is worth sharing, “Evidence based programs known to be effective at reducing smoking should be intensified among groups with lower education, and health care providers should take education level into account when communicating about smoking hazards and cessation to these patients.”
Here is the CDC table listing state smoking rates.
TABLE 2. Estimated prevalence of current cigarette smoking among adults,* by sex and state/area --- Behavioral Risk Factor Surveillance System (BRFSS), United States, 2008
Much to my chagrin, I cannot paste the tables in here so that they are in any way readable. This is only the half of it, HOWEVER, it is the lower half! Please go to this CDC link . You will see a much better image of the nations smoking rates.
There is more that might interest you in the data.
Monday, November 16, 2009
This same vaccine, known as NicVax, was discussed in an USA Today piece this morning. There was no new information in the article. It discussed how the vaccine worked and that the National Institutes of Health had granted 10 million dollars to the company that has made the vaccine. There were phase one and two trials, but now the drug will be used in very large phase three clinical trials. The ten million is for the clinical trials.
Before I saw the article in the paper, I had read on line that GlaxoSmithKline was working on a licensing agreement with the company that makes the vaccine. The company is Nabi Biopharmaceuticals. The agreement will give GSK exclusive rights to market and sell the drug should it be FDA approved for use. GSK is paying 40 million dollars up front for this and Nabi expects that with all "fees and regulatory, developmental and sales milestones" it could net 500 million. They will also benefit from royalty fees.
A reason GSK, who produces and sells the nicotine patch, gum and lozenge, could be forward thinking and hoping on this can be found in a statement from the USA Today article. The statement was comparing the nicotine vaccine and the similar cocaine vaccine. It is felt that the nicotine vaccine is going to have a lot more support from drug companies because it "would be much more profitable."
So as I said before, if anyone can beat Big T it is going to be Big P, and I AM right about this!
Sunday, November 15, 2009
Trends: The ACSM has been conducting a world wide survey of trends related to fitness and the health industry for four years. It is an impressive sampling, though the return rate is only 15%. The response for 2010 trends included almost 1500 professionals from several countries. It is important to note that they are tracking trends ( an indication of long lasting behavior change), not fads. There is significant criteria to make the list. There may be things on the list in the top ten or twenty spot that drop off after a couple of years, and those are then deemed to be fads that were longer lasting than usual. Of note, for what is expected this year (which is often the same as the last four years), is children and obesity, special fitness programs for older adults, personal training, core training, strength training, balance training and comprehensive health promotion programming at the worksite. The first and last are my favorite, but they are third and twentieth on the list. Oh what I wanted to say was that in the little blurb about special programming for older adults, which certainly emphasizes activity to keep the person as active, strong and independent as possible and which is a trend due to the aging baby boomers, I saw some new terminology. The terms used were - more active older adult, the ATHLETIC older adult and the frail elderly. I can tell you which one I strive to be. (from ACSMs Health and Fitness Journal V 13 N 6)
Fish Oil: From the same ACSM journal cited above comes additional information on Omega 3s and what fish oil is proven and not proven to do. I KNEW from hearing experts, reading research and visiting the AHA website, that fish high in omega 3s or essential fatty acids and fish oil supplements reduced the inflammation markers for heart disease and could prevent it. There are other conditions for which evidence supports a benefit of consumption of these fatty acids. I have already written about this in several posts. What I was able to better grasp today was that the three poly unsaturated fats that are important are (briefly) ALA, EPA, and DHA. We actually get a lot of omega 3 fatty acids every day, but most are ALA and it is not the ALA that protects. Also, our bodies do not sufficiently convert this ALA to DHA and EPA so we should consume at least two 3 oz servings of fatty fish a week. See previous posts and links for fish that are lower in mercury, dioxin and PCBs. Of note, shrimp DOES have omega 3s and canned tuna is a good source too. Salmon is of course, the best. Fish oil supplements DO protect for cardiovascular disease but DO NOT reduce the inflammation associated with vigorous physical activity. There fore, I am reconsidering my daily fish oil supplementation as I, unlike most of the country, do not have any heart disease indicators.
Caludication: I was listening to the radio and heard this commercial asking "do you suffer from intermitent caludication?" And I kept thinking, I know what that is. Why do I know what that is? What is it? OH<>
Therapists: Okay, before I say my piece let me be fair and clear. My early career was as a child focused social worker and later a psychiatric social worker, so yes, I have done counseling in a general way. I have dear friends who are psychiatrists and psychologists and I certainly respect the therapeutic relationship. That being said, I also believe that sometimes, therapists just need to shut the hell up. It is helpful to talk with someone about where you are so you can be where you really need to be. Sometimes, but NOT always, that involves a check in with the past, the very far away past. Today at the pool, I hear a man talking on his cell phone. I heard these little blips of conversation and cannot begin to know what the real topic was. It seemed he was talking to a friend or family member about a relationship. He was having real problems with his girl. He said something like, "sex is the most powerful..." and damn, I didn't hear the rest. Then something about falling asleep?? and then , "my therapist said that having something like that happen when I was so young ... yeah, six or seven... would be very hard on a person." Then he said, "no, I don't really remember anything, but the therapist said...."
And that is when, well, I packed up my stuff to leave because I just didn't want to hear anymore, but I thought, not too kindly, "that therapist needs to shut the hell up."
OK, that's it then...
Saturday, November 14, 2009
In a way it is a two or three part post on my experience. It involves second and "third" hand smoke and triggers to use tobacco.
Firstly, I conduct or facilitate quit smoking classes and groups as part of my job. Many times smokers wonder about drinking without smoking. The two acts are entrenched for smokers, and it takes some time to separate them. Last week in one of my classes, we discussed what to do when newly quit and going out to drink. Our responses ranged from not drinking, to drinking at a restaurant, to using a cocktail straw, and lastly, having some nicotine gum on hand. Then someone asked me when I had quit, 1/2/97 and if I still had cravings. I do not have cravings in general and I do not have them when I am faced with old triggers.
Last night I was at a bar that allowed smoking. I didn't realize it at first. Because the doors were open, front side and back, the smoke didn't hit me hard. It usually does as I am very sensitive. Seeing a person here or there with a cigarette in their hand was just mind boggling for me. I paid attention though, and No, it did not make me want one. I did not feel like I needed to have a cigarette in one hand and a beer in the other. I was fine with just the beer!
When I left the bar (two beers in three hours) and sat in my car, then it hit me. I seriously thought, "what is that smell?" It took a minute, but yes, my hair and my clothing had the cigarette smell.
So let me explain the 1st. 2nd, 3rd of it.
First hand smoke is what the person smoking the cigarette inhales into their lungs only. It is a toxic mix of particulate matter that causes or exacerbates numerous disease states and also activates several neurotransmitters in the brain.
Second hand smoke is what they exhale as well as what is emitted from the lit cigarette. (we refer to this as mainstream and sidestream smoke) SHS is deadly and there is no safe level, only lower doses.
The particulate matter I mentioned doesn't just evaporate, it settles on anything in the room where the smoke was exhaled or emitted. That means it settles on YOU> It settles on clothing, furniture, walls, hair and skin. Particulate matter is microscopic. You can not see the chemical residue but it infiltrates lungs and is what we refer to , in total, as TAR.
We have surgeon generals' reports on smoking, smokeless tobacco and second hand smoke. I expect there will be one on the residue as well. Earlier this year, folks at MassGeneral Hospital for Children, in Boston, began calling this "stink" third hand smoke. I disagree with the name, but certainly get the concept.
So for myself, I say this. The night out was FUN. I did have a SHS headache for much of the morning and had to cleanse my skin and clothes of the smoke residue and so for this reason, I do support total public smoking bans.
Believe it or not, the less places a person can smoke, the less triggers they will have when they make their QUIT and the more successful their quitting will be.
Friday, November 13, 2009
1) Exercise that involves the large muscles with large movements that is intended to increase your heart rate for an extended period of time.
2) Cardiovascular has to do with our heart and lungs. The heart pumps blood that we need to live and the lungs supply our oxygen. Cardiovascular exercise improves the performance of our heart and lungs. This is a GOOD thing.
3) Start low and slow. Use low impact activities like walking and cycling. Work up to twenty minutes a day three days a week. From there, try to do some cardiovascular exercise every day, but vary the activity and increase the intensity. When walking, add a few minutes of running. When cycling find some hills! Take an aerobics or dance class. Learn a new sport. When you are exercising most days of the week, and still only doing 20 or 30 minutes, then add minutes! Another thing to do is add times! Walk 20 minutes two or three times a day instead of one 60 minute session.
I said dance didn't I? Okay then, best I get ready to go and hear that band now.
Thursday, November 12, 2009
They have been accused of and settled cases for inappropriately marketing drugs such as Neurontin, Bextra and Celebrex. The drug company has encouraged physicians to prescribe the medications for indications that are not FDA approved. Physicians can prescribe medications as they see fit, but advertising has to be strictly for the ON LABEL use.
Not only has Pfizer broken the rule with providers but also in some of their direct to consumer advertising. But that is all OLD news.
Now we have learned that the clinical trial data that Pfizer presented to the FDA for approval of Neurontin( an epilepsy drug) to treat new conditions, was, well, fudged. In a current lawsuit, the company is accused of withholding reports that were negative and in some cases, changing the study design in order to promote positive findings.
My response to this latest news is this. If they did it with Neurontin then they did it with other drugs. So which other drugs did they also misrepresent to the FDA, to scientific journals, to health care providers and to consumers? Are you taking a drug made by Pfizer?
Here are a few: Zoloft, Viagra, Aricept and Lipitor
Unfortunately, the list of products from Pfizer is huge and you will have to go to their website to look yours up. Though I hate to link to it, here it is!http://www.pfizer.com/products/rx/prescription.jsp
At this time I have a serious amount of concern regarding the veracity of this company.
Wednesday, November 11, 2009
Here is the bottom line as I understand it. [Men in the study were at least 65 years old with an average age of 75. They lived in communities, not nursing homes. The participants lived in several states across the country. The men were tested at baseline and four years later]
The scientists took certain biometric measures of the participants. This included their height, weight, BMI and fat percentage. Blood work was also completed. Specifically the men were tested for sex hormone levels and the sex hormone binding compound known as SHBG, the G stands for globulin.
The men were also put into categories based on five criteria. The categories were robust, intermediate and frail. The criteria for categorization were:
1) weakness - based on grip strength
2) slowness - based on walking speed
3) activity level- activity level was assessed for all men and the men in the lowest 20% met the criteria (you can see the criteria is for frailty not robustness!)
4) sarcopenia or shrinkage - meaning having a low lean body mass for their height and weight
5) and exhaustion - as measured by loss of breath or having to stop while walking short distances
If a man met three or more of the five he was said to be frail, if he met one or two then he was intermediate and the absence of any of the above meant he was robust.
The scientists expected to see some correlation between hormone levels and frailty. What they did find was that the men who met the frailty criteria at the start of the study, or at base line, WERE low in bioavailable testosterone.
No other hormone was related to frailty. Bioavailable testosterone is free or available for the body to use. Perhaps a lack of this BAT leads to muscle atrophy and weakness, but that was a hypothesis not a conclusion.
Four years later however, it wasn't testosterone levels that predicted frailty but having been frail OR older at the initial screening. If one is frail, he tends to stay frail and if he is older he is more likely to become frail. [this was not a study to see if frailty could be reversed, but I think it is possible that it could be]
From time one to time two, which was ONLY four years, about 11 % less men were robust, 5% less were intermediate and an additional 3% were frail. The most startling number of all, however, was that 12% had died.
I do not know what the prevention message can be except to say that some testosterone levels can be affected, i.e. lowered, by obesity, medications, injury and other conditions. If muscle strength and cardiovascular conditioning are the markers of frailty, then certainly, staying active and doing weight resistance exercises is paramount.
Tuesday, November 10, 2009
I tried, I really tried to hold out faith in the food industry. Maybe, I thought, maybe they will respond to the obesity epidemic and make low cost health food available to the people that need it the most. I was wrong. And not only do the make bad food cheap, they make bad food fancy and expensive. It is like they want to make sure whichever financial situation the parent is in, they will be pulled to the processed and or unhealthy food. [a perfect "affluent" example is chunk white albacore tuna and a less affluent is Sunny D or another cheap fruit juice meant to take the place of soda and thus be better for your kid]
This is about about fruit juice. You have read here and in several other places that children need their fruits and vegetables. You should also be hearing that they need them on a plate. (this is true for adults as well) You may recall this blog post
inspired from a training I attended. The scientist was expressing concern about fructose. He is not the only scientist or obesity specialist that I have heard refer to this. The problem is not sugar in fruits and vegetables but those sugars being taken out of context, so to speak. When sugar comes in an apple, along with the skin - water and fiber included, it is treated differently by the body then if it comes in juice. Also, in juice it is a concentrated sugar. It takes several apples to make a glass of juice. You can end up with 160 calories of juice in a small glass when an apple only has 80 calories.
So who do you suppose the company Adam & Eve are targeting with their Fruitables line? They have several different flavors including several Sesame Street options. Kids will probably ask for them. The advertisements remind us that children need fruits and vegetables. In another bullet, the ad notes that many beverages are full of sugar.
Let us look at the Bert and Ernie's Berry. It is 100% juice. This one comes in an 8 ounce serving but some of the others I looked at say that the serving size is 4 ounces, and that is indeed better. But this particular one has 120 calories and 25 mg of sodium and 25g of sugar. There is a little symbol next to the sugar content to let you know that this is naturally occurring from the fruit juice. The drink has no fiber. It has no protein. It has sugar and salt. In fruits you do get protein and fiber and less calories.
Fruitables are NOT a health food. And remember, just because something occurs naturally does not mean it is safe. Doesn't radon gas occur naturally in our environment?
Monday, November 9, 2009
I usually entertain thoughts of blog postings early in the day so that in the evening I will have a focus for writing. I was actually thinking maybe there would be a magazine or newspaper in the lobby that would get my attention when I noticed a wall board with the heading Healthy Advice.
There were eight pamphlet holders on the wall board and each had some literature. Two of the slots held coupons for CEREAL with the suggestion that by eating these cereals, Cheerios and Fiber One or some thing like that, you could lower your cholesterol. [ I believe that this is one of the health claims that is currently being evaluated. Not because what you eat and what you do are not important, but because letting someone with high cholesterol think that a bowl of Cheerios will keep their arteries from clogging is dangerous.]
Then there was a pamphlet about a medication that could treat your OAB. Yes, you know, you name the disease, make a cute acronym for it, create a pill and then sell the hell out of it. The acronym stands for Overactive Bladder.
Another pamphlet promoted Yaz for your birth control needs, while Sally Field smiled at me from a Boniva brochure. Next to Sally was one for a drug called Evista that has something to do with breast cancer, though I read on the front of the pamphlet that Evista doesn't prevent or treat it (?) Oh I get it. Some times being treated for breast cancer can put you at risk for osteoporosis and this drug can help with treatment related osteoporosis. AH....
Then there is the ubiquitous Lipitor, perhaps the best selling drug in the world. [an article at Forbes.com states that last year the world wide sales were over 12 billion and 7 billion of that 12 was from the USA]
And there was something about an antacid, but the name of the pill was not on the cover of the pamphlet and I did not OPEN any of these :)
There was one about Insulin. Apparently, too many diabetics have switched to the newer drugs and sales for good old insulin must be down. The healthy advice on this pamphlet encouraged people to "rediscover" insulin.
Oh, the drug I railed about in a recent post had a pamphlet too. Trilipix. This is another cholesterol lowering medication that is also supposed to raise HDL and lower triglycerides. This drug is meant to be taken with another statin drug, oh, I think that Lipitor is a statin!! Anyway, the reason I got myself in a knot was that the outcome, reduced heart attack or heart attack death, was NOT changed by adding this drug which does bring side effects to the party.
Is that eight?
THEN, in the bathroom there was a cup that held markers (WHY? You had to ask. I am guessing it is to write your name on your pee cup, but since I was not there for THAT I am only assuming this to be so) Anyways, the cup said, Lexapro. Lexapro is an antidepressant.
I had to look hard for something in the exam room, which comforted me. But there it was, the little knee knocker tool - it said Bextra. Ah Bextra, you went the way of Vioxx because people who take you DIE - apparently its a good knee knocker, but I wasn't there for that either!
And that is all about my enlightening visit to a primary care office. Oh, then there was the TV, and lucky for them - I only got to see the part about replacing whole milk with skim milk and butter for olive oil before they called my name, because you KNOW , the next part would be how you should take a drug when those things didn't lower your cholesterol!! [because on the frame of the TV were those same words, Healthy Advice. Anyone want to wager on WHO bought that TV?]
I wear me out ... but I already know what tomorrows blog will be so everyone else is safe for another day.
Sunday, November 8, 2009
Fruits and Vegetables
Saturday, November 7, 2009
I was sent a link to someone else's blog by a personal trainer, dancer, runner, friend that I respect very much. The blog post was incredibly technical and I am still scratching my head over it. Jennifer thought I would be interested, and I was, but oh boy, I was hard pressed to follow along.
Firstly, it seems that the energy burn we long for has a lot to do with the oxygen consumption we do after our exercise. In fact, this is called EPOC to stand for excess post exercise oxygen consumption. EPOC is only one measure of physiological change we cause during exercise that contributes to calorie burn. I know you have heard of lactic acid threshold and maximum heart rate, those too are involved. Along with this is the individual characteristic of YOU and also the activity you are doing and how long and hard you are doing it.
I could break down the blog post that I read but you know, the bottom line is really what matters.
If you want to increase your metabolism or calorie burn for any length of time after your workout then you need to push yourself beyond your comfort zone. You should run, swim, cycle, dance, step, etc. , so hard that you lose your breath. You should lift weights so that the muscle in question burns and quivers and no further reps are possible. You have to lift HEAVY or do full body resistance like push ups and pull ups.
Exercise at less intense levels and you will absolutely benefit and burn calories. If you are going to tell yourself that three hours later you are still burning more calories than most people, then you really have to work for it.
Another thing I read in my book today - the people I teach or coach have more control over their health outcomes then I do. If you want this, then go out and get it.
Friday, November 6, 2009
The direct to consumer advertising by drug companies that I so LOATHE is apparently not as bad as I thought it would be, at least as far as outcomes go.
A BusinessWeek article explained that the billions of dollars spent by companies like Merck, Eli Lilly, Pfizer, and GlaxoSmithKline, etc to promote drug seeking behavior by patients only led to about 23 requests for drugs. These 23 requests were found in a study of over 12000 doctor patient conversations in 2008.
Furthermore, those annoying, often gross side effect voice overs ARE getting our attention. We tend not to remember the drug we saw advertised as much as we remember the bad things it could do to us. I was glad to see that the very expensive ads on anti depressant drug Cymbalta did not make it more popular and that sales of sleep aid Ambien actually went down!
The only winner mentioned in this article was Boniva. Apparently, Sally Field is a trustworthy spokesperson.
The article was quite good you might like to read it.
Thursday, November 5, 2009
In our country about a quarter of a million people will have an operation every year to manage the clogged arteries that accompany heart disease. This is done by grafting arteries so that the clogged ones, the ones that are so occluded blood may eventually get stalled in them, are by passed altogether.
I learned today that the most popular way to have coronary artery bypass grafting surgery (CABG) is either on pump or off pump. In other words, one's heart and lungs are either kept operating by a machine or they are not. It is very confusing to read about and more so to explain, though the heart is stopped in the off pump method, blood is still circulated but it must be done so manually.
Many studies have been done to see which procedure is safer and or more effective. A very large and randomized clinical trial was recently reported on in the New England Journal of Medicine. In that study of over 2000 Veterans Affairs patients, the off pump surgery led to more adverse outcome in the following year. There were more heart attacks, repeat surgeries and deaths. The difference in these events for the two groups was only 3% but of course that would matter if it were you or your loved one.
The on pump one is then better in some cases. Of course, no one is willing to call this conclusive and the study population, mostly men and mostly younger ones (well why younger?! isn't heart disease for old people?) anyway, they do not represent the country by any means.
It took me a while to find research on which procedure costs more but I found at least one to say that the off pump procedure was LESS costly. So there you go. This would be a case where comparative research shows that the more expensive procedure is safer and better!
I have to tell you that in trying to educate myself a little bit on the whole grafting thing, I became even more convinced of never eating high fat foods again.