News News News
NSAIDs INCREASE STROKE RISK 28 TO 86 PERCENT
Treatment with various types of non-steroidal anti-inflammatory drugs was linked with a significantly higher risk for strokes in a review of a million people from the Danish general population during 1997-2005; “Commonly used NSAIDs [non-steroidal anti-inflammatory drugs] such as diclofenac and ibuprofen were associated with an increased risk of hemorrhagic and ischemic stroke,” and the link showed a dose-response relationship, reported Dr. Gunnar H. Gislason.
The public needs “increased awareness about the cardiovascular risk of NSAIDs, even in healthy people,” said Dr. Gislason, a cardiologist at Gentofte Hospital in Hellerup, Denmark.
In a multivariate analysis that controlled for age, gender, co-morbidities, and concomitant medications, people treated with ibuprofen, diclofenac, rofecoxib, or celecoxib had a statistically significant, increased risk for fatal or non-fatal stroke. The increased risk ranged from about 30% higher among all ibuprofen users to about double in all diclofenac users. The two coxibs each linked with about an 80% increased risk. The only NSAID studied without a significantly linked risk was naproxen.
In general, the risk increased at higher dosages. For example, among ibuprofen users who averaged 1,200 mg/day or less had about a 20% increased risk for fatal or non-fatal stroke on the days they took the drug. People who took more than 1,200 mg a day had an average increased risk of about 80%. Both increases were statistically significant.
A second analysis showed significantly increased risks for ischemic stroke among ibuprofen and diclofenac users, but not among users of naproxen, rofecoxib, or celecoxib. Again, users of ibuprofen and diclofenac faced a greater risk when taking higher dosages, defined as being more than 1,200 mg/day of ibuprofen or at least 100 mg/day diclofenac.
THE PRESSURE FOR ELECTRONIC MEDICAL RECORDS CONTINUES…
Even though there is no assurance that the data will be kept private. The Connecticut attorney general has already collected $250.000.00 in a settlement with health insurer Health Net after they lost a disk drive with personal information on 500.000 subscribers. The state’s insurance department has fined the company an additional $375,000.00.
Of course this money will not prevent any misuse of the data, nor will it compensate any patients for any damages resulting from the security breach, who are being offered “free credit monitoring”. Huzzah! (American Medical News November 29th, p 47).
THE PRESSURE FOR ELECTRONIC MEDICAL RECORDS CONTINUES…
Even though a survey by the Healthcare Information and Management Systems Society suggests that at least 25% of practices and hospitals are not even assessing the risk that they may suffer a breach of computer security. (http://www.ama-assn.org/amednews/2010/11/22/bisc1122.htm).
A recent Harris poll found that 91% of adults would not return to a business if their personal information were stolen, but patients in the medical system have no alternative if their insurance company, their hospital, or a government agency such as the Veteran’s Administration fails to keep their medical information private, as in 2006 when more than 25 million veterans’ personal and family information was compromised. (http://www.securityfocus.com/news/11393).
THE PRESSURE FOR ELECTRONIC MEDICAL RECORDS CONTINUES…
Even though specialists cannot meet the bureaucratic requirements for “meaningful use” without exemptions.
One of the selling points for EMRs is that data that is presently obtained only when it is clinically relevant will be obtained by all primary practices. However, many specialists are not likely to hire personnel to collect irrelevant studies and services: For example, an ophthalmologist may not routinely enter blood pressure readings into their electronic medical records, so the Department of Health and Human Services is working on ways that requirements will be varied for each specialty so as to smooth the process of establishing a comprehensive medical database on every citizen.
These constantly changing regulations will require a new, expensive bureaucracy for rule making and enforcement, and compliance will divert more energy and time away from patients for busy clinicians.
CHINESE MEDICINE EFFECTIVE FOR CONSTIPATION
TCM interventions appear to be useful in the management of constipation, according to a systematic review from an Australian group.
One hundred and thirty-seven studies met the inclusion criteria, of which 21 were high-quality trials. Eighteen of the trials were of Chinese herbal medicine (CHM) and three were of acupuncture.
Significant positive results were found in 15 high-quality studies. CHM was more effective than conventional medicines in eight trials. Of the 10 remaining CHM trials, nine compared the CHM being studied with another CHM and the results were significant in four trials. The effective rate was significantly higher in the intervention group than in the placebo group in the last CHM study.
One of the three acupuncture trials compared acupuncture with conventional medicine; one compared it with Senna (Cassia angustifolia) and one with a deeper acupuncture technique.
The therapeutic effect in the treatment group was more effective than that in the control group in all three studies. The authors urge that the results should be interpreted cautiously due to heterogeneity in diagnostic procedures, interventions and outcome measures across the studies. (Efficacy of Traditional Chinese Medicine for the Management of Constipation: A Systematic Review. J Altern Complement Med. 2009 Dec 3. [Epub ahead of print]).
CHINESE HERBS CAN HELP PREVENT DIABETES
A Cochrane database systematic review carried out by Australian authors has assessed the effects and safety of Chinese herbal medicines for the treatment of people with impaired glucose tolerance (‘pre-diabetes’).
The researchers considered data from 16 clinical trials including 1391 people who received 15 different herbal formulations.
Meta-analysis of eight trials showed that those receiving Chinese herbal medicines combined with lifestyle modification were more than twice as likely to have their fasting plasma glucose levels return to normal levels compared to lifestyle modification alone. Those receiving Chinese herbs were less likely to progress to diabetes during the study period (one month to two years).
No adverse effects were reported in any of the trials. (Chinese herbal medicines for people with impaired glucose tolerance or impaired fasting blood glucose. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006690).
HERBAL MEDICINES SAY NO TO CIRCULATORY DISEASE
Research suggests that traditional Chinese herbal medicines (TCMs) used to treat cardiovascular disease may act by producing large amounts of nitric oxide (NO).
NO is a chemical messenger molecule that is crucial to the cardiovascular system because of its vasodilating action. It promotes blood flow through the heart and circulatory system, eliminates blood clots, lowers high blood pressure and reduces formation of atherosclerotic plaques. Many cardiovascular diseases are characterized by NO insufficiency.
The scientists tested a number of TCMs - including single herbs such as Dan Shen (Salvia miltiorrhizae Radix) and Gua Lou (Trichosanthis Fructus) as well as herbal formulae - for their ability to produce NO. All of the TCMs tested showed NO bioactivity through their nitrite and nitrate content and their ability to reduce nitrite to NO via the activity of the enzyme nitrite reductase.
Many of the TCMs were found to have nitrite reductase activity 1000 times greater than that of biological tissues, providing a natural system for generation of nitric oxide in the inner walls of blood vessels and thus accounting for some of their therapeutic effects. Each of the TCMs tested was also found to exert vasodilatation in an animal model. (Nitric oxide bioactivity of traditional Chinese medicines used for cardiovascular indications. Free Radic Biol Med. 2009 Sep 15;47(6):835-40).
OMEGA 3 FATS AND ATRIAL FIBRILLATION
Some data suggest that omega-3 fatty acids may be a safe and effective treatment option for patients with atrial fibrillation. In a randomized, placebo controlled, multicenter trial that enrolled patients with documented symptomatic paroxysmal or persistent AF and no structural heart disease, high dose (4 grams a day) of a prescription omega fatty acid (Lovaza) was not effective. Prior, smaller studies have suggested a protective benefit from consumption of fish and other fish oil preparations, so these results may reflect differences in populations studied, or limitations of the prescription preparation. (JAMA December 1, 2010 Vol 304:21 p 2363).
ACUPUNCTURE & DEPRESSION
Previous studies have shown acupuncture at depression specific points to be superior to acupuncture at points not specific to depression. In a recent study, however, it appears that the non specific acupuncture was superior to the specific acupuncture.
Study participants (151) were randomized to receive depression specific acupuncture, non-specific acupuncture or no treatment (waiting period) for eight weeks. All patients eventually underwent the depression specific acupuncture.
At the end of the first eight weeks, the effective response was 22%, 39% and 17% respectively in the three groups. By the end of the study around half of patients had responded to the treatment.
One notable factor is that while the depression-specific acupuncture was tailored to the individual patient at the first session, the study required those same points to be treated during the remainder of the study period. (Acupuncture for Depression: A Randomized Controlled Trial. Journal of Clinical Psychiatry 2006; 67: 11, 1665-1673).
ACUPUNCTURE & ALLERGIC ASTHMA
In a randomized controlled study, patients of 18 years or older with allergic asthma were assigned to routine care plus acupuncture (15 sessions over three months, 184 patients) or routine care alone (173 patients). Patients who did not consent to randomization also received acupuncture (1088 patients).
At three months, asthma specific quality of life and health-related general quality of life improved significantly in both acupuncture groups compared to controls. (Effectiveness of acupuncture in patients with allergic asthma – the Acupuncture in Routine Care (ARC) Study. Focus Altern Complement Ther 2006; 11: 06-7).
IRREGULAR WORK & PROSTATE CANCER
It is already known that shift workers are at a higher risk of developing some cancers, including breast and colorectal. Now a new study as uncovered a significant increased risk of prostate cancer among rotating shift-workers.
The researchers believe that the cause may be disturbance of melatonin secretion. (Am J Epidemiol 2006;164:549-555). Another study as identified two other risk factors for prostate cancer. One is height of greater than 1.7 meters (5’7”) at age 20, and the other is a long marriage (among men married only once and still married at interview). (Risk factors for prostate cancer: A national case-control study. Int J Cancer 2006;119:1690-1694).
"Is Anyone Thinking?" Department
PROMISE THEM ANYTHING
Our plan will lower annual health care costs by $2500.00 for a typical family. For Americans satisfied with their current health insurance, nothing will change except their costs will go down.
Americans will also be able to choose from a range of private health insurance options though a new National Health Exchange, which will establish rules and standards for participating plans. The Exchange will also include a new public plan that will provide coverage similar to the kind members of Congress give themselves.
Senator Barack Obama, "Affordable Health Care for All Americans", Journal of the American Medical Association, October 22/29, 2008 p. 1927
AMA Agitated Over Absence of Payoff
One of the ways organized medicine tried to sell "reform" to doctors and the public was to assure their membership that the little people would benefit just like themselves, the intermediate-level fat cats.
In order to buy support from physicians and their handlers, six provisions were added to the bill to provide increases in Medicare payments to doctors, and these were to be retroactive to the beginning of 2010.
But, Lo! Here it is 2011 and there never was a payment of the estimated 200 million dollars that should have been paid to doctors last year. The American Medical Association sent an inquiry about the payments in a letter to Health and Human Services Secretary Kathleen Sebelius on December 10th, but to no one's surprise, there has been no response.(American Medical News Dec 27,2010 p 2)
The 2008 promises that of reducing the costs of the program by "eliminating waste and inefficiency" has been revealed as impossible, as no where in the thousands of pages of the bill is "efficient" medical care defined.
Nor is there any insight or mechanism into determining what constitutes waste and inefficiency.
Indeed, as has been pointed out before, the continuing theater of health reform has been solely about controlling cash flow, and who will define where it will go. The present law essentially removes all of the decisions as to what is important, and, what it is worth, from both the doctor and the patient, and has placed it firmly and irrevocably in the hands of regulators, politicians and lobbyists.
Unfortunately, the interests of regulators, politicians, and lobbyists are often diametrically opposed to those of the patient and the physician.
Kathleen Sebelius is not going to respond to the AMA because she doesn't even know which bureaucratic operation will control the payments promised in the "Affordable Care Act" of 2010. she probably doesn't even know if the regulators and committees that will administer the law are in place.
In the June 2009 newsletter I reported the May 2009 promise by the President and various favored health care organizations that they would save 2 trillion dollars over the next decade.
That would be about 317 billion dollars in reduced health care costs by now.
I predict that doctors are as likely to see the promised 200 million dollars as the American people are to see that promised 2 trillion dollars.