Myhealth - KiwiDoc

Been away a while

2008-04-12T17:02:00.002+12:00

Have been on an island off coast of NZ. The internet was a bit sluggish. Have satellite internet coming. Hope its fast enough. Have winter wood supply chopped up and ready. The work isn't too onerous. Plan organising my recent research and then see where that takes me. As I do this and if internet is adequate I shall be uploading heaps of good stuff.

see ya

Books to read

2008-04-12T16:50:00.010+12:00

Here's sample from Good Calories Bad Calories

And here a list of books to consider

If you get diabetes read this book Dr Bernstein Diabetes solution - he is a doctor with IDDM from his teens and is now in his 70s. Years ago he had complications of diabetes - most of these have gone. If I had diabetes I’d be seeing this guy.

If you worry abiut your weight read this one - Fat Politics J eric Oliver Phd . You folk with a BMI between 25 and 30 may live longer than those with BMI between 20 and 25.

If you want to know what is known and what is not known - from science point of view - about fat, diet, food etc read this - Good Calories bad calories Gary Taubes science journalist. It’s a bit detailed but this guy knows his stuff and most of what we, lay persons and doctors alike, think we know is BS.

If you have hypertension read the chapter on it in this book - Malignant Medical Myths Joel Kaufman Biochemist.

If you have been told you have prostate cancer read this one - Prostate cancer prevention and cure lee Nelson huntingdon press las vega isbn 0-929712-14-5. He’s a doc with tis disease. It’s a medical book and it is very detailed.

Any type of cancer - go to cancerdecisions. com. This is the website of ralph Moss. If I get cancer of any kind I will be buying one of his reports. About to have chemo or radiotherapy buy one of his books or less expensive reports.

If your doctor is raving on about cholesterol read this The Cholesterol Myth Uffe Ravnskov Medical doctor and this The cholesterol con by Malcolm Kendrick uk GP. Ask your doctor what absolute risk reduction is? Then ask what the NNT is ie number needed to treat. Then ask what the NNH is number needed to harm. Then ask what the mortality rate is for those who take the pills and those who don’t is. Is the absolute risk reduction about death or what?

If you are wondering about mammograms or PSA read these two - The last well person Nortin hadler professor medicine Should I be tested for cancer H Gilbert Welch professor medicine. Ask your doctor what the number needed to screen is to prevent one death.

If you are thinking about having an arthrocopy for OA of your knee or a back operation read the above book - The last well person.

If your surgeon wants to perform a coronary artery by pass on you read - The last well person. as well as Heart Frauds Charles T McGee Medical doctor

Overdosed America John Abrahamson. This guy is a or was a GP attached to harvard. He has a go at cholesterol, HRT, osteoporosis and a few other things - loved this book.

If you have familial hypercholesterolaemia read the above Cholesterol Con book.

Google Mary G. Enig, PhD to find out about fats.

That’s it for now folks.

Medical Myths

2007-11-09T10:57:00.000+13:00

Evidence-Based Medicine for Student Health Services
Robert J. Flaherty, MD
Swingle Student Health Service
Montana State University
Bozeman, MT 59717 Medical Myths
http://www.montana.edu/wwwebm/myths.htm

General	Hematology/Oncology	Pain Control
Allergy/Immunology	Obstetrics/Gynecology	Pulmonology
Cardiology	Ophthalmology	Radiology
Continuing Education	Orthopedics	Surgery
Endocrinology	Otolaryngology	Urology

Here is an example
. Myth: The United Kingdom Prospective Diabetes Study (UKPDS) of 5000+ patients followed over 20 years, showed:
a. Hyperglycemia in Type II diabetes is a continuous, modifiable risk factor for clinically important outcomes and that reduction in glucose is the key to improving outcomes
b. Tight blood glucose control is an important goal in Type II diabetes
c. Intensive treatment of Type II diabetes is beneficial

7. Reality: A closer and more objective look at the UKPDS data clearly shows:
a. The medications used (glibenclamide, chlorpropamide and/or insulin) to lower blood glucose concentrations produced no significant benefit on any single macrovascular end point for any group of patients
b. Metformin reduced progression of retinopathy and reduced the frequency of the aggregated diabetes-related endpoints, all cause mortality, and stroke compared with the sulphonylureas and insulin or diet alone
c. The benefit of metformin is not necessarily related to its hypoglycemic effect
d. Decreasing HgbA1c using medication did not improve any clinical endpoint

WHAT DO YOU MAKE OF THIS????

McCormack J, Greenhalgh T, Seeing what you want to see in randomised controlled trials: versions and perversions of UKPDS data, BMJ 2000 June 24, 320:1720-3. PMID: 10864554
Shaughnessy AF, Slawson DC. What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes. BMJ 2003 Aug 2; 327(7409): 266. PMID: 10864554

Mammography

2007-11-09T10:56:00.000+13:00

Bandolier on this subject

Breast screening again

2007-10-21T15:53:00.000+13:00

The Center for Medical Consumers takes the position that as long as one team of researchers found considerable harm and uncertain benefit, it remains unclear whether symptom-free women should continue having regular mammograms. Arguably, the analysis conducted by Gotzsche and Olsen is far more in-depth and more thoroughly peer-reviewed than other analyses of the same trials. Their critics have judged the increased- mastectomy finding to be obsolete because mastectomy is no longer the only treatment for breast cancer. But Dr. Gotzsche counters that in some countries, mammography-detected carcinoma in situ is currently treated with breast removal in about one-third of all cases (Letters to The Lancet, 2/1/02). This year alone, an estimated 54,000 U.S. women will be diagnosed with carcinoma in situ, according to the American Cancer Society. Most will be treated with six weeks of radiation therapy, and some will be treated with mastectomy.

Breast screening

2007-10-21T15:17:00.000+13:00

SCREENING FOR BREAST CANCER: WHAT TO DO WITH THE EVIDENCE

Harris, R., Am Fam Phys 75(11):1623, June 1, 2007

The author, from the University of North Carolina and a member of the U.S. Preventive Services Task Force, addresses the continuing controversy regarding breast cancer screening. He notes that screening is, on the whole, beneficial among women aged 50-69, leading to a modest reduction in breast cancer mortality (number- needed-to-screen [NNS] to prevent one death after 14-years, 838). The potential benefit is less in women aged 40-49 (NNS 1,792), while there is little evidence regarding women over the age of 70, who have been excluded from most studies. Screening over the course of ten years in any of these groups can be expected to produce at least one false-positive test in about 50% of women, prompting anxiety and further (needless, but potentially harmful) procedures. In light of this evidence, the author recommends that screening (every two years) be encouraged for women aged 50-70. For women aged 40-49, however, he recommends discussion of the possible harms and benefits, to allow them to make an informed decision. He similarly recommends shared decision making for women over the age of 70, while acknowledging the impossibility of providing them with any clear information about benefits and harms. He also notes that patients with a strong family history should be referred for genetic counseling. Finally, he cites good evidence that breast self-examination is not useful and should be discouraged, and notes that there is insufficient evidence regarding a possible role for screening MRI or other newer radiographic techniques. 12 references (afpserv@aafp.org)

The above abstract comes from here

Article below comes from here
The first stirrings began last December, after The Lancet carried an article by two Danish scientists questioning the value of breast screening. Peter Gotzsche and Ole Olsen caused an outcry two years ago by suggesting screening did not save lives, after reviewing the results of seven trials involving 450,000 women. In a follow-up article last October, they repeated their analysis and said they were now even more sure their earlier claims were correct. They concluded that the small difference in deaths was caused by the way the trials were designed, not by any effect of screening.

Harvard gazette

A New Study Provides Additional Reasons to Avoid High Doses of Statin Medications

2007-10-21T10:43:00.000+13:00

In articles posted at MedicationSense.com in recent months, I discussed the findings of two major studies of maximum-dose 80-mg Lipitor (atorvastatin). Despite the authors' claims that these studies proved the benefit of maximum-dose Lipitor for preventing heart attacks and strokes, the MedicationSense.com articles revealed that maximum-dose Lipitor caused far more liver injuries than placebo or low-dose Lipitor. Even worse, despite a reduction in heart attacks and a slight reduction in strokes, there was no improvement in overall mortality because more subjects on maximum-dose Lipitor died of other causes including cancer.

Should you take asprin to prevent heart attack

2007-10-18T22:54:00.000+13:00

Well should you
Thiw will downlaod a pdf file

Statins again.

2007-10-18T21:30:00.000+13:00

Talk given by Uffe Ravnskov in Sidney August 2006

Malcolm Kendrick. Short but interesting. WHO data

Aborigines have the highest rate of cardiovascular disease (CVD) - lowest cholesterol
Swiss have highest cholesterol and lowest CVD.

Evidence for Caution: Women and statin use A meticulous 36-pages report about the senseless and dangerous use of statins in women.

Are Statins Overused?, by Malcolm Kendrick

The above all come from here

Here is Ellison's E Book The hidden truth about cholesterol

According to Ellison, studies have consistently linked high cholesterol to lower mortality. For example:

Low cholesterol is associated with heart arrhythmia.

The European Heart Journal published a 3-year study of 11,500 patients finding those with low cholesterol to have a risk of all-cause death 2.27 times higher than those with high cholesterol.

The Journal of Cardiac Failure published an analysis of 1134 patients with heart disease and found low cholesterol to be associated with the worst outcomes in heart failure patients and impaired survival, while high cholesterol improved survival rates.

The American Geriatrics Society reported in 2003 that, in patients over the age of 65, even cholesterol levels up to 417 mg/dL were associated with lower mortality compared to levels under 189 mg/dL.

Flu vaccine

2007-10-18T16:42:00.001+13:00

The researchers found no evidence that the vaccine lowers therisk of admission to hospital in winter among elderly patientswith acute respiratory disease (Vaccine doi: 10.1016/j.vaccine.2007.09.005).

There are other papers that say just the opposite
Hows a poor statistical ignoramus t sort these things out.

Here one suggesting all we docs should take the needle

CONCLUSIONS: Programs to promote and facilitate influenza immunization for healthcare workers appear to reduce influenza-related morbidity and mortality in the elderly
Hayward, A.C., et al Br Med J 333:1241, December 16, 2006
RESULTS: Overall vaccination uptake rates, including full- and part-time staff, were 35% in intervention homes vs. 5% in control homes in 2003-2004, and 31% vs. 4% in 2004-2005. Vaccination rates among residents exceeded 70%. During 2003-2004, there was a statistical reduction in selected resident outcomes in intervention homes during the influenza season, including influenza- like illness (11% vs. 23%, NNT 4.5), hospital admission and GP consultations for influenza-like illness (0.3% vs. 2% [NNT 20.4] and 10% vs. 19% [NNT 5.8]), and all-cause mortality (11% vs. 15%, NNT 8.2). Similar trends were observed in 2004-2005, although overall influenza activity during that period was very low.

Should young people be given antidepressants?

2007-10-18T16:35:00.000+13:00

(1) Should young people be given antidepressants?
(Head to Head: Should young people be given antidepressants?)
Yes: http://www.bmj.com/cgi/content/full/335/7623/750
No: http://www.bmj.com/cgi/content/full/335/7623/751
Not sure whether this is free or not

serotonin syndrome

2007-10-16T16:45:00.000+13:00

The manifestations of the serotonin syndrome fall into three general areas:

Cognitive or behavioral changes such as confusion, agitation, lethargy, and coma.
A condition that is referred to as autonomic instability that includes elevated temperature, rapid heart rate, sweating, nausea, vomiting, diarrhea, and dilated pupils.
Neuromuscular changes that include spasm or twitching a muscle or group of muscles, exaggerated reflexes, and tremor.

Here's a list of drugs that have been associated with this according to article in bestpillsworstpills

cervical cancer vaccine

2007-10-16T16:28:00.000+13:00

Here is a question and answer format that seems straight down the middle.
It's 15 US a year to use this very worthwhile site.

Concerned re side effect

2007-10-16T16:15:00.000+13:00

It's only 15 US per annum.
The cut and paste below comes from here - it's free
Here is some more free stuff on drugs

Each year, in hospitals alone, there are 28,000 cases of life-threatening heart toxicity from adverse reactions to digoxin (DIGITEK, LANOXICAPS, LANOXIN), the most commonly used form of digitalis (drugs that regulate the speed and strength of heart beats) in older adults.
Each year 41,000 older adults are hospitalized — and 3,300 of these die from ulcers caused by NSAIDs (nonsteroidal anti-inflammatory drugs, usually for treatment of arthritis). Thousands of younger adults are hospitalized.
At least 16,000 injuries from auto crashes each year involving older drivers are attributable to the use of psychoactive drugs, specifically benzodiazepines and tricyclic antidepressants. Psychoactive drugs are those that affect the mind or behavior.
Each year 32,000 older adults suffer from hip fractures attributable to drug-induced falls, resulting in more than 1,500 deaths. In one study, the main categories of drugs responsible for the falls leading to hip fractures were sleeping pills and minor tranquilizers (30 percent), antipsychotic drugs (52 percent), and antidepressants (17 percent). All of these categories of drugs are often prescribed unnecessarily, especially in older adults.
Approximately 163,000 older Americans suffer from serious mental impairment (memory loss, dementia) either caused or worsened by drugs. In a study in the state of Washington, in 46 percent of the patients with drug-induced mental impairment, the problem was caused by minor tranquilizers or sleeping pills; in 14 percent, by high blood pressure drugs; and in 11 percent, by antipsychotic drugs.
Two million older Americans are addicted or at risk of addiction to minor tranquilizers or sleeping pills because they have used them daily for at least one year, even though there is no acceptable evidence that the tranquilizers are effective for more than four months, and the sleeping pills for more than 30 days.
Drug-induced tardive dyskinesia has developed in 73,000 older adults; this condition is the most serious and common adverse reaction to antipsychotic drugs, and it is often irreversible. Tardive dyskinesia is characterized by involuntary movements of the face, arms and legs. About 80 percent of older adults receiving antipsychotic drugs do not have schizophrenia or other conditions that justify the use of such powerful drugs, so many of these patients have serious side effects from drugs that were prescribed inappropriately.
Drug-induced parkinsonism has developed in 61,000 older adults also due to the use of antipsychotic drugs such as haloperidol (HALDOL), chlorpromazine (THORAZINE), trifluoperazine (STELAZINE), fluphenazine (PROLIXIN), and thioridazine (MELLARIL). There are other parkinsonism-inducing drugs as well, such as metoclopramide (REGLAN), prochlorperazine (COMPAZINE), and promethazine (PHENERGAN), prescribed for gastrointestinal problems.

Read this book - Overdosed America

2007-09-28T07:19:00.000+12:00

It's a very eloquent read re the depressing direction modern medicine is going in - it's written by an ex academic family doctor. In particular if you want a clear picture of the cholesterol saga, it's in this book.

Having fun - surely it must be good for you.

2007-09-14T01:41:00.000+12:00

Been on holiday - another month or two to go

2007-09-14T01:31:00.001+12:00

My brother and I with our Basque Berets - we reckon we look pretty good. Another month and I wil have to put my medical hat on - do some reading and catch up! Any ideas gratefully accepted.

Want to see my holiday snaps, NZ shots - help yourself here

When I get medical brain going again will start blogging here again.

Conversations with my brother re medicine and where its going are disturbing. Either I am becoming an old fuddy duddy or we are really heading down some dead end alleys - time will tell and I'd like to be live long enough to find out. Have fun - surely this is more important than living a few years longer.

xenical

2007-08-09T02:27:00.001+12:00

The Diet Drug Orlistat (XENICAL) and Gallstones
(June 2007)
Yet another problem has been detected with this diet drug whose approval we opposed and that we have been attempting to get banned. The FDA found 37 cases of gall stones in patients using orlistat. This, in addition to inhibiting the absorption of important vitamins such as A, D, E and K as well as evidence that the drug can cause pre-cancerous abnormalities in the colon of animals, further emphasizes why this barely effective drug should not be used, either in the prescription version called Xenical or the about-to-appear over-the-counter version, Alli.

Low-Dose Aspirin for Heart Protection: How Low Should a Safe Dose Be?

2007-08-09T02:22:00.000+12:00

Daily aspirin protects the heart, but the dose at which this can be safely accomplished has never been established. It has long been known that the risks of aspirin—gastrointestinal or brain hemorrhage—cannot be completely eliminated even at the lowest possible doses. An international team of researchers recently determined that daily doses of aspirin as low as 30 mg are adequate for achieving the anti-clotting goal; whereas doses higher than 75 to 81 mg merely increase the risk of adverse reactions without providing any additional advantage.

Screening for Stroke, Peripheral Artery Disease and Abdominal Aortic Aneurysm

2007-08-09T02:20:00.000+12:00

Mass screening for vascular disease is a relatively new idea. Before plunking down your money, the question to be answered is this: Have any studies proven that detecting and treating this symptomless problem will either prolong my life or improve its quality?

Avandia Debacle

2007-08-09T02:17:00.000+12:00

Scarcely two weeks after the Senate overwhelmingly passed legislation touted as a major fix of FDA’s failing effort to assure drug safety, The New England Journal of Medicine published an analysis linking the diabetes drug Avandia to a 40% increase in the risk of heart attack. This finding is especially troubling because people with diabetes are already at high risk of cardiovascular problems. A million diabetics are estimated to be current Avandia users in the U.S.

Se here for rest of article

BP oh dear

2007-08-09T00:07:00.000+12:00

Their findings were that 'Shockingly, we have found that the Framingham data in no way supported the current paradigm to which they gave birth. In fact, these data actaully statistically reject the linear model.'

Treating hypertension with guidelines in general practice

ARE ANTIDEPRESSANTS AS EFFECTIVE AS CLAIMED?

2007-08-09T00:04:00.000+12:00

NO, THEY ARE NOT EFFECTIVE AT ALL

Click here to hear the Reviewer's comments via MP3.

Moncrieff, J., et al, Can J Psych 52(2):96, February 2007

This British author challenges the tenet that antidepressant drugs specifically act on abnormal cerebral states to relieve depression. She points out that meta-analyses of the myriad of published randomized, controlled trials comparing antidepressants and placebo generally show only a small advantage of active treatment, further noting that trials with negative results are much less likely to be published. The author suggests that reported effects of antidepressant drugs might be due to nonspecific sedative effects of these agents on outcomes such as sleeping difficulties and anxiety rather than to a truly antidepressant effect. She cites the findings of naturalistic studies that have reported that patients treated with antidepressants do less well than those who are not so treated. The prevalence of depressive episodes, suicide and sickness absence due to depression has been progressively increasing in western countries, despite a profound increase in antidepressant prescribing, suggesting that the use of antidepressants has done little to reduce the consequences of depression. Addressing studies reporting relapse of depression after discontinuation of long-term antidepressant therapy, this author feels that this phenomenon does not necessarily provide evidence of the effectiveness of antidepressants but rather might reflect the occurrence of discontinuation symptoms that are mistakenly diagnosed as early signs of relapse. In support of this premise, she cites the findings of one meta-analysis of maintenance antidepressant studies reporting that relapses tended to cluster after withdrawal of treatment, with the risk declining thereafter. The author concludes that there is no reason to suppose that the diverse problems that are labeled as "depression" can be reversed by antidepressant drugs. 9 references (j.moncrieff@ucl.ac.uk)

Put this in your pipe and smoke it

2007-07-17T04:03:00.000+12:00

These trials, which had the lowest risk of erroneous results and a combined total of 180,938 participants, showed the following increases in mortality per antioxidant: 7% for beta carotene; 16% for vitamin A; and 4% for vitamin E ( the trials tested a wide range of doses; for example, Vitamin A doses ranged from 2,000 IU/day to 200,000 IU/day). The Cochrane reviewers concluded that ongoing trials looking at vitamin C and selenium should continue.

Menopause guidelines

2007-07-16T06:25:00.000+12:00

Here tis

What does define Myalgic Encephalomyelitis

2007-07-15T20:11:00.000+12:00

What defines M.E. is not ‘chronic fatigue’ but a specific type of acquired damage to the brain. Myalgic encephalomyelitis is an acutely acquired illness initiated by a virus infection with multi system involvement which is characterised by post encephalitic damage to the brain stem; a nerve centre through which many spinal nerve tracts connect with higher centres in the brain in order to control all vital bodily functions – this is always damaged in M.E. (Hence the name Myalgic Encephalomyelitis.) Central nervous system (CNS) dysfunction, and in particular, inconsistent CNS dysfunction is undoubtedly both the chief cause of disability in M.E. and the most critical in the definition of the entire disease process.

Clinical Review - schizophrenia

2007-07-14T00:54:00.000+12:00

From the bmj

Hip replacement delays

2007-07-14T00:51:00.000+12:00

Delays in surgery for hip fracture have a significant effecton short and longer term outcome. An Israeli multicentre surveyconducted over four years found that people who had surgerywithin two days of fracture had lower mortality while in hospital,and at one month and one year, than did those who waited formore than four days for surgery. Large variations were seenbetween hospitals, and the authors call for a prompt reviewof quality improvement (International Journal for Quality inHealth Care 2007;19:170-6 doi: 10.1093/intqhc/mzm003).

Reluctance to sit or stand

2007-07-14T00:50:00.000+12:00

An 11 month old infant presented with a four week history ofreluctance to sit or stand. He had no fever, tenderness, orother abnormalities on examination, including that of the lowerlimbs, hips, and spine. Investigations revealed normal fullblood count, inflammatory markers, and blood culture. Radiologicalinvestigations included a normal radiograph and ultrasound scanof the hips. A magnetic resonance imaging scan of the lowerlimbs and pelvis performed under general anaesthetic was normal,and that of the spine confirmed a diagnosis of lumbar discitis.Identifying the aetiological agent in discitis is difficultas blood cultures are usually negative, but Staphylococcus aureusis reportedly the most common causative organism. Serologicalinvestigations in this child were negative.

Nicotine patches in ICU

2007-07-14T00:48:00.000+12:00

Giving very sick patients nicotine replacement therapy may notbe entirely safe, although it is sometimes given to smokersin the intensive care unit (ICU) to prevent withdrawal. A retrospectivecase-control analysis of this treatment in ICU patients foundthat it is associated with increased in-hospital mortality—20%in smokers who took the treatment versus 7% in those who didnot. Treatment remained independently associated with increasedmortality when severity of illness and invasive mechanical ventilationwere adjusted for (Critical Care Medicine 2007;35:1517-21 doi:10.1097/01.CCM.0000266537.86437.38).

Betablockers post MI - NICE guidelines

2007-07-05T17:56:00.000+12:00

early after an acute MI, all patients without left ventricular systolic dysfunction or with left ventricular systolic dysfunction (symptomatic or asymptomatic) should be offered treatment with a beta-blocker
for patients after an MI with left ventricular systolic dysfunction, who are being offered treatment with a beta-blocker, clinicians may prefer to consider treatment with a beta-blocker licensed for use in heart failure
beta-blockers should be continued indefinitely after an acute MI
after a proven MI in the past, all patients with left ventricular systolic dysfunction should be offered treatment with a beta-blocker whether or not they have symptoms, and those with heart failure plus left ventricular systolic dysfunction should be managed in line with 'Chronic heart failure' guidance
after a proven MI in the past, patients with preserved left ventricular function who are asymptomatic should not be routinely offered treatment with a beta-blocker, unless they are identified to be at increased risk of further cardiovascular events, or there are other compelling indications for beta-blocker treatment
beta-blockers should be initiated as soon as possible when the patient is clinically stable and titrated upwards to the maximum tolerated dose.

Diabetes and actos like drugs

2007-07-05T17:30:00.000+12:00

Rosiglitazone and Cardiotoxicity — Weighing the Evidence

David M. Nathan, M.D.
Worstpills bestpills has a do not use notice on these drugs. Subscription to their website is minimal. They look for what's wrong rather than what's right and good on them!! They have some recent stuf on actos and sibling meds.

Prostate

2007-06-30T00:08:00.001+12:00

Download video
This site is extensive and patient orientated - set up by someone with cancer I think. You'll hear from doctors and patients. Bundles of articles and links. Great place to start. To get to site click on image above.

Some objectivity on all the diet rubbish

2007-06-29T09:36:00.000+12:00

The more I’ve learned, the more horrified I’ve become. Science is being misused for marketing and political purposes. Evidence is being distorted and bias has inundated media, research, government policies and clinical guidelines. Unsound information proliferates in professional and advocacy organizations, academic institutions and journals; and even professionals aren’t reaching beyond beliefs to critically examine studies and recognize credible information. So much valuable and critically important information, and the very best science — well documented in careful, objective, evidence-based research — is never reported and never published. Fear sells and unfounded scares, exaggerations and “what-ifs?” are being used to terrify people about their foods, bodies and health.

Diet from our ancestors

2007-06-29T06:25:00.000+12:00

Introduction to the Paleolithic Diet is Ben Balzer's page. He is a family physician in Australia. Probably the clearest introduction on the web.

These two guys nail it!

2007-06-29T06:21:00.000+12:00

Are lipid-lowering guidelines evidence-based?
Lancet: Vol 369 January 20, 2007
J Abramson and JM Wright

They nail what we know, what we don't know and what we need to know.

Here's more from one of them

Complicating the statin issue even more for women, the five studies of statins that examined the risk of breast cancer found a 33 percent higher rate in women taking statins than in those taking placebos. There were not enough women in these studies to make this increase statistically significant, but clearly more research is needed here. In fact, a large clinical trial based at the University of California, San Diego, is now quantifying the extent to which statin users experience a variety of adverse effects.

Here he is being interviewed
You'll need quicktime for this. Fast forward past the Tony Blair bit. A statin promoter is on first.

Wheezy kids prior to diagnosis of asthma!!!!!!

2007-06-28T17:36:00.000+12:00

Murray, C.S., et al, Lancet 368:754, August 26, 2006

METHODS: This double-blind, controlled British study, sponsored by GlaxoSmithKline, examined the effect of early initiation of inhaled fluticasone in 200 young children who were randomized to active or placebo treatment after two confirmed episodes of wheezing or one prolonged (more than one month) episode. Fluticasone was initiated at a dose of 100mcg twice daily; the dose was reduced every three months to the minimum required to control symptoms. The patient age at the time of randomization was 0.5-4.9 years (median, 1.2 years) and follow-up was continued until the age of five, when information was available for 173 children.
RESULTS: Upon completion of follow- up, there were no statistically significant differences between the groups in the percentage of children with wheezing in the prior twelve months or the percentage with physician-diagnosed asthma. There were no differences in the use of asthma medications, measures of lung function or airway reactivity. The active treatment group had lower median daily symptom scores and fewer unscheduled physician visits for wheezing during the third month of the study, but not during the first two months. Open-label treatment with inhaled fluticasone was permitted in children whose symptoms were not controlled after three months, and there were no significant differences between the two study groups in the percentage of children ultimately treated with open-label fluticasone.
CONCLUSIONS: Early introduction of maintenance inhaled fluticasone in preschool children with wheezing was not associated with a significant reduction in the progression to asthma or improvement in lung function by age five years. 31

Here you statin pushers - read this chap!

2007-06-28T13:00:00.000+12:00

Unless you are highly informed you wouldn't have a chance arguing with this guy

Ravnskov U. Fat myths and cardiovascular disease. BMJ. 30 Mar 2001
Ravnskov U.Evidence that a high cholesterol does not cause atherosclerosis BMJ. 28 Apr 2001
Ravnskov U.New guidelines for converting healthy people into patients. BMJ. 28 May 2001
Ravnskov U.The side effects from the cholesterol lowering drugs may offset their benefit. BMJ. 19 Aug 2001
Ravnskov U.The diet-heart idea: wishful thinking, impossible to refute. BMJ.28 Oct 2001
Ravnskov U.Premature conclusions from the Heart Protection Study. BMJ. 16 Nov 2001
Ravnskov U Non-dietary factors explain the lower cholesterol concentration associated with frequent eating. BMJ. 16 Jan 2002
Ravnskov U How to mislead in preventive medicine. BMJ. 4 Feb 2002
Ravnskov U.Chance of surviving with and without treatment 17 Jun 2002
Ravnskov U. Association does not prove causation and is not the same as a dose-response relation. BMJ. 15 Jul 2002
Ravnskov U. Statins And Cancer: Cause For Concern BMJ. 21 Oct 2002
Ravnskov U. Questionable benefit from polypill treatment BMJ. 13 Jul 2003
Ravnskov U. Teleoanalysis - a misleading term BMJ. 15 Sept 2003
Ravnskov U. Unfounded allegations about dietary fat.BMJ. 5 Oct 2003
Ravnskov U. Serum cholesterol - a surrogate outcome BMJ. 6 Oct 2003
Ravnskov U. The diet-heart idea is kept alive by selective citation. BMJ. 8 Dec 2003
Ravnskov U. Missing figures from the INTERHEART study BMJ. 14 Oct 2004
Ravnskov U. Dietary fat is not the villain.BMJ. 26 Jul 2005
Ravnskov U. Lowest possible statin dose better than a low LDL cholesterol. Ann Intern Med 17. Oct 2006
Ravnskov U. Further evidence that higher statin doses are ineffective. BMJ 19. Oct 2006
Ravnskov U. Beware of the carbs! BMJ 8. Dec 2006

Asthma and LABAs and steroids

2007-06-28T10:31:00.000+12:00

Long-Acting Beta2-Agonists -- Where Do We Stand?

There's areal push going on here.

Who will win the war

Great site for doctors

2007-06-28T07:27:00.000+12:00

For a couple of hundred dollars a year you get Rick and Jerry discussing 40 abstracts each month to do with primary care or emergency medicine, Rick is front line doc and Jerry an academic doc who works in an emergency department as well as being a critical appraiser. As likable as Rick is I get these abstracts to hear Jerry. We need many more docs like Jerry. He does the statistical and methodological stuff. Sounds great but is it?

Here they talk about blood pressure pills

Here they talk about aggressive treatment of CVD in the elderly

Jerry should write a book for us front line docs - please Jerry

If placing these audios from this great site upsets the guys and or gals who own it please let me know and I'll take them down. I have put them here hoping more docs will listen to Rick and Jerry.

What do I want more information on at the moment?

Long acting beta agonists - there is a major push going on with regards these. NMow we are supposed to be using one of them in a similar way to ventolin.

Quicken Mac Dates - convert qif solution

2007-06-27T22:53:00.000+12:00

Bloody hell. Changed banks and I couldn't import qif from my new bank into quicken like I could with my old bank. Opened qif from both banks in text editor. The one that worked had dates in a US format and the one that didn't had pommie dates.

I've spent three nights googling and mucking about.

Solution found - I downloaded a programme called checkbook. Imported QIF file from new bank. Exported it. Opened file in text edit and compared it to file that worked. Besides dates the first few lines differed too. I deleted these and hey presto it worked.

It was a bit more complex than this. Quicken for mac has a Canadian and US setting choice. My computer has various date settings of course. Checkbook has different date settings for importing and exporting.

What works for me is to import qif file in checkbook via dd/mm/yy option and export using mm/dd/yy setting with quicken set to canada and dates on computer set to nz.

It worked - phew!

Blood pressure - what level to treat.

2007-06-26T07:16:00.001+12:00

Port, S., et al, Lancet 355:175, January 15, 2000

So for a 60 year old male that's a systolic of 160 and for a female 164.

Today doing a locum I met two men whose GP was trying to get their BPs below 140. Both had systolic in the 150s. Both were having side effects. Both felt pushed and forced. Both felt threatened - scared.

I just do not get pushing people into following guidelines without their buy in. I detest the use of fear to gain compliance no matter how politely it's used

Fitness

2007-06-21T09:33:00.000+12:00

CONCLUSIONS: Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality. (Zillions of references here to do with fitness)

Dieting - increases your CVD risk - bloody hell.

2007-06-21T09:24:00.000+12:00

Dr. Reubin Andres of the National Institute on Aging admitted that weight loss can improve blood sugar levels, blood pressure and cholesterol in the short term. “The only problem is that when you look at mortality rates,” he said, “they don’t look good. Fat people who are subject to weight loss have a higher mortality rate than those who remain fat.”

Statistics are like a girls bikini - they show a lot but hide the vital parts. Truth is an illusive ideal. Sloganeering the easy option!

Where is the epidemic?

The emperor's new crisis!

In fact, Blair and colleagues are renowned for decades of research showing weight is not a significant predictor of mortality, it's fitness........

It's getting scary.

2007-06-16T13:11:00.000+12:00

Medical research is largely or more and more being funded by drug companies - DCs.
The universities and their professors are becoming largely dependent upon DCs.
So are medical journals.
DCs are not primarily interested in the potential for harm.
They have been known to with hold information.
DCs have no interest in unprofitable treatments.
They have a duty to their shareholders not to patients.
They do what's expected of them.
Their influence is everywhere.
They need new drugs which can be patented.
Lifestyle drugs is the name of the game.
It's in their interest to have as many people as possible taking pills.
They have done great things for us but they should not control research to the extent that they do.

Guidelines are becoming a standard to judge performance and determine pay.
More and more of our top medical scientist are being helped financially by the DCs.
Too many sit on guideline committees while being paid by DCs whose products are under consideration.
Too many of our guideline producers have career conflicts of interest too.
Too many do not see these conflicts of interest as a problem.
Their mistakes and prejudices are becoming enforced on the workforce under the guise of evidence based medicine.
Tops scientists for instance should not be the ones to decide on the validity of research in their field of interest. Do the research have others crunch the numbers.
We need independent critical appraisers arguing the pros and cons of research.
Anyone being paid by a drug company should be excluded from having any a seat on anyy guidelines committee.

Evidence based medicine is a great boon and a potential trap
What is true today may not be tomorrow.
Findings may be plain wrong.
Things can be fudged.
DOEMs become more important than POEMs (disease as opposed to patient orientated evidence)
(what matters is not your cholesterol level for instance but where you have an MI stroke etc or not)
Statistical tricks can be played.
Very few doctors have the ability to sort wheat from chaff.
Critical appraisers with no conflicts of interest are a rare breed.
Once something becomes a truth it's very hard to change

Doctors are losing power to the politicians and managers.
Their livelihoods more and more dependent upon, not patients, but those that pay them and control their right to practice.
Controllers love guidelines - so would I if I was one - they simplify.
It's not their job to determine whether guideline are the truth or not.
Doing so would complicate their lives.
They tell us guidelines are only guidelines yet demand explanation if one steps out of line.
The professional and government bodies are part of this system too. They too use guidelines.
Doctors are controlled beings. If not they will be.
They are becoming less and less able to act out of their own knowledge or even the knowledge of experts that disagree with guidelines.
They are destined to become obedient souls - soldiers - unless things change.

Doctoring is becoming more and more a business rather than a profession. The yard stick - when your doctor is with you are they putting your interest before their own? Are they interested in you or more interested in their computer's requests - thats' where the money is? Ask them what's the evidence? Whats the countering evidence? What's the number needed to treat and harm? Who funded the research? Does he or she know the interaction of all those drugs she or he is offering? If you ask me, you'd get a lot of don't knows! Are you prepared for the discomfort of there being no certainty - only possibilities and probabilities

It's getting scary out there. Not too bad just yet maybe but the future looks grim to me.

Here's some of my stuff on these issues

Tight control of sugar levels in type 2 diabetes. Take a look at this for an example of differences in interpretation of evidence. As good as no benefit over less tight control

Things are not black and white. The more one knows the more Grey they become. Managers and controllers can not handle grey. Individual doctors and patients can but that's too anarchistic for the piper payers. The two people that matter in the moment are being taken bit by bit out of the game. But even for the doctors and their patients the whole business is too time consuming - better just to rely on those guidelines. Mostly they are pretty good but ......

Paranoid - yup.

A letter to a dear friend

2007-06-16T12:43:00.001+12:00

Here is a bit of a rave in response to your feeling at fault - being the cause of your troubles. It's a bit philosophical - not meant to be personal - kind of working things out for myself I suppose.

We give ourselves too much credit - we all do - for our successes and failures. The issue is how much are we creators of our experience or more importantly to what extent is the ego in control?

So here goes - the ego or 'I' is powerless and yet thinks it isn't. The 'I' that thinks it creates reality is an illusion. It's just thought - a product of thought. Thought produces the 'I". The 'I' is a servant of thought. Thought being all the learned, conditioned stuff that makes up what we call mind. There is a sense or feeling of 'I' but there is no actual thing which exists. It's never been found or located. There is no place for it except in the imagination. As kids dream up imaginary friends so we dream up the 'I'.

For those that claim there is an 'I' and it is in control, I ask where is it and how does it control anything? A thought arises - I want a lolly. That thought then stimulates should I or shouldn't 'I'. A yes or know arises. The action then follows. The 'I' thinks it is in controls. Simple observation tells me this isn't so even though I feel it is.

Does this make you and I as mind body things powerless - hell no. But when the 'I' tries to run the show then we end up experiencing powerlessness or the fake power of one aspect of thought pretending its running the show when it isn't - conditioned thought is. An aspect of thought that calls itself 'I' tries to control its source - the power base out of which it arises. Thought continues to do it's thing. The 'I' attempts to resist. It's a bit like having a foot on the accelerator and brake at the same time. It's nuts.

When things are going well there isn't an issue. When fear runs the show - not feeling so good - then control becomes an issue for us all. This is the "I"'s fuel.

I am feeling low angry depressed. Firstly where are these things low, angry, depressed etc - what are they? Secondly assuming the 'I' exist what does it use to control them - what does it have to act on them with? Does it have mental hands or what? In what space and time can it act?

When it is truly known that the 'I' has zero power to do anything beyond maybe resist, the problem is solved - that is when thought stops trying to control thought something else arises. It's not solved - it simply goes. When there is the slightest glimmer of a feeling that 'I' can do something, which is how it is for all of us, nothing much changes until the issue sinks out of awareness - until of course it gets triggered again.

And yo yo away we go till we die - it's a bugger.

Am I personally free of this shit? No! I have, however, experienced non resistance and allowing reaction in it fullness to be and the 'problem' vanishing into thin air. Now, of course, the 'I", the f...ing ego, knows this experience and so tries to make it happen. Guess what it doesn't work. It may seem to succeed but not really. It may distract us for a while but change anything of substance - of course not. It's the cause.

My answer to you my dear friend is to express yourself in words, painting, music, with others or whatever takes your fancy - let it all hang out and let it be. Let the dam be washed away - stop holding it up. Be curious fascinated interested in the games your 'I' plays. Watch it. Don't try to act on it. If you do it's just the 'I' in another disguise.

Your life is your life. There are no have to's. In your private space or with those you trust give full expression to all thoughts/feelings. Let things be. Allow the process no matter how silly or 'bad' it may seem. Easy to do - probably - well in theory anyway. But not in actuality for most of us except in retrospect. The 'I' has been around a while. It's an habituated automatic phenomenon. It's like a knee jerk. It's just a mental burp. Our brains make it happen. The whole thought process is based in physicality - conditioned reflexes of great complexity and intricacy - way beyond the 'I's ability to understand let alone control.

My personal belief is that when we are able to allow with no resistance the truth of who we are in the moment to be, love, whatever love is, is - operates us: And where love is, the ego isn't and suffering ends until of course the ego gets it act together again. With love - curiosity, interest, intelligence, exploration, discovery and newness are. Power - not power over or any of that shit - is too.

Yes a lot of our reality comes about because of who we are but it,s not under our direct control. When, however, we allow love to be, change happens to us and reality changes too but this has bugger all to do with the ego or our ability to control anything. Love happens, Change happens. It all happens. The only choice it seems to me is to resist or be the ride. And part of the ride will be storms, crap and death.

Just remember I love you no matter what - and so does - think about it - you know who. You don't have to be and do anything to please me. If I get displeased, then I have something to deal with either in my private space or with you. And when you and I are honest emotionally with each other we move into new places together. It may temporarily be difficult but not when we look back.

You and I are very special to each other but in the grand scheme of things we are of no more importance than one leaf is to a tree!! The tree doesn't give a tinker's damn if one leaf is a better leaf than another. In the grand scheme of things, you and I are insignificant specks. Yet in our little neck of the woods you matter to me and I know I matter to you.

So go with it, allow what is to be, allow change to happen and enjoy the ride because after all, what is actual, you and you and your experience, is all there is.

When shit is happening let the emotional impact of it be fully expressed - change will happen. Will you become immortal, enlightened, saved from the actualities of life? No! But you will be more at peace, more able to deal with what is - more able to die to what truly doesn't matter. What is that? Your ego and its suffering which at the moment you think is you.

You are so much more than your petty pathetic winging or crowing ego. You are life being expressed. Let your life be expressed and let it take you way beyond what you ego pretends it can offer.

I love you

your dear dear friend

PS
In some twisted way we seem to prefer the struggle to freedom. I wrote a book once my working title was Fighting To Die The Cost Of Living Is Too High. The cartoon below speaks to this a wee bit.

See you very soon - LOL and LOLs

PPS you know who this started out to. It's turned into a personal rave for me!!

Coeliac disease

2007-06-16T01:02:00.000+12:00

Here's a pdf file on coeliac disease

You can be obese and have this disease

Blog a few back suggest those with fatigue should be checked out for it too.

A pile of guidelines from NZGG

2007-06-15T23:52:00.000+12:00

NZGG

Population Screening for Colorectal Cancer

Prostate Cancer Screening in New Zealand

A Guideline for the Management of Heart Failure: health professionals guide

Assessment and Management of Cardiovascular Risk

New Zealand Cardiovascular Guidelines Handbook: Developed for Primary Care Practitioners

The Management of People with Atrial Fibrillation and Flutter

Management of Type 2 Diabetes

Guidelines for the Management of Heavy Menstrual Bleeding

Management of Dyspepsia and Heartburn

Depression: information for health practitioners

Guidelines for Medical Practitioners Using Sections 110 and 110A of the Mental Health (Compulsory Assessment and Treatment) Act 1992

Guidelines for the Use of Acetylcholinesterase Inhibitor Drugs in the Treatment of People with Alzheimer's Disease

Diagnosis and Management of Soft Tissue Knee Injuries: Internal Derangements

Diagnosis and Management of Soft Tissue Shoulder Injuries and Related Disorders

New Zealand Acute Low Back Pain Guide, incorporating the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain

Analysis of Chronic Fatigue Syndrome Guidelines

Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation

Diagnosis and Treatment of Adult Asthma

Management of Asthma in Children aged 1-15 years

The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2006

Guidelines for the Management of Genital Herpes in New Zealand

Hormone Replacement Therapy

How come these have come out black

medical podcasts

2007-06-15T22:11:00.000+12:00

There's a lot of them listed here

Here is some others

Mcgaw Hill medical blogs

Johns Hopkins PodMed

JAMA

Great blog site for docs

2007-06-15T20:41:00.000+12:00

Things like the following can be found here. Want a refreshing fresher take a peek here. You name it he's got it

Central line placement. See also Central line placement with ultrasound guidance.

Thoracentesis (pleural tap)

Paracentesis (ascites tap)

Arthrocentesis (joint tap)

Arterial line placement is illustrated in The Internet Journal of Health.

Lumbar puncture in eMedicine

Case histories galore, examination how tos - great possie.

What's your doctor up to

2007-06-15T20:24:00.000+12:00

When your doctor is listening to your heart, tapping your reflexes and feeling your tummy what's she or he up to. Here you will learn all about it with video and sound tracks - it's kind of cool. Here heart sounds and find out why you are being asked to touch the docs finger and then your nose.

depression- the two questions

2007-06-15T17:00:00.000+12:00

Two questions may be used to screen for depression(with 97%sensitivity): "During the past month have you oftenbeen botheredby feeling down, depressed, or hopeless?" "Duringthe past monthhave you often been bothered by little interestor pleasurein doing things?" A positive answer to either questionsuggestsdepression.

rapid response
The original research by Arroll.B et al showed a high sensitivity (97%) but a low positive predictive value (PPV) (18%)and the post-test probabilities were that there would be 5 false-positives for each true- positive.
This does not mean that the two questions are of no value as the high sensitivity means that they are an excellent method for excluding depression as the cause of tiredness. The chances of a patient with a negative test having depression are only 0.3%.

Tiredness

2007-06-15T16:55:00.000+12:00

Here tis

I have yet to see a diagnostic criteria list for fatigue that is complete. This unfortunately includes the diagnostic criteria for Chronic Fatigue Syndrome issued by CDC. No wonder we keep citing CFS as a cause for fatigue when we ourselves fail to pinpoint the diagnosis. In my endocrine practice after ruling out the obvious causes of fatigue (mentioned in this 10-minute consultation, I will also add adrenal insufficiency which is an autoimmune disease not mentioned by name in the mini consultation), I will do the following tests and I almost always find the cause for fatigue: 1. True biological reference range of TSH should be 0.3-2.5. If TSH is > 2.5, especially when Thyroid Peroxidase titer is > 10, the patient might have evolving hypothyroidism. If you go by your laboratory's reference range of 0.5-5, of course you will miss the boat, and resort to the waste basket diagnosis of CFS.
2. Check glucose tolerance test on people who are obese, have family history of diabetes, and have nocturia, or polyuria. The fasting plasma glucose should be <>
Check vitamin B12 level. The cutoff reference range is >300 pg/mL (>221 pmol/L), or even higher. Most laboratories in the US have the reference range at 160 or 180, erroneously low. If in doubt, check homocysteine level, the reference range of homocysteine should be between 5 and 15 µmol/L (some authorities use 10 as cutoff). If you rely on outdated reference range, you miss the boat and fall in the trap of CFS.
3. In the Northern regions of the United States and Europe, vitamin D deficiency is rampant. In some cities in the United States 70% of the population in the winter might have vitamin D deficiency (such as Boston). Vitamin D deficiency is responsible for calcium and phosphorus absorption (among other host of other functions). Lack of phosphorus means lack of ATP in the body, which means that you feel tired. I have helped thousands of victims of this type of chronic fatigue through vigorous vitamin D supplementation. Not to mention that vitamin D deficiency causes also severe myalgia and bone pains (osteomalacia), often missed since vitamin D deficiency is not on the list of differential diagnosis of fatigue, including (tragically) the CDC list. Failure to recognize vitamin D deficiency leads you to misdiagnosing patients as CFS and/ or fibromyalgia. Nearly 70% of patients with fibromyalgia have vitamin D deficiency, i.e. misdiagnosed. The true reference range of 25 hydroxy vitamin D is 32-100 ng/ml.
4. Sleep deprivation is a very common cause of fatigue. This was mentioned in the 10-minute consult.
5. Celiac disease is relatively common (~1% of Caucasians have it, most of them undiagnosed). If you don't think of Celiac, you will be an easy victim in the trap of CFS. Celiac can cause pan-malabsorption of iron, vitamin D, B12 (mentioned above) in addition to other nutrients and minerals.
6. If iron saturation is high, perform genetic testing for hemochromatosis. This is another relatively common genetic disease in the Caucasians.

Here's my gal again

2007-06-14T21:47:00.001+12:00

Gorgeous

The more I read the more I go fuzzy

2007-06-14T08:02:00.000+12:00

Are Law and Wald aware of data from Framingham, which show that falling cholesterol concentrations are directly associatedwith an increased risk of coronary heart disease?³ Are theyaware of research from Japan that shows a completely inverse relationbetween rising cholesterol concentrations and deaths from coronaryheart disease?⁴ Hundreds of papers contradict the associationbetween raised cholesterol concentrations and death from coronaryheartdisease.

Shestov in his lipid clinics study in Russia even showed an inverse relation, with higher rates of coronary heart diseasein patients with hypocholesterolaemia. The Honolulu study showsthat, in people older than 50, a low cholesterol concentrationis by far the most important risk factor for premature death.⁵Law and Wald did not show one curve relating to cholesterol loweringtheJ shaped curve of total mortality with 5.2 mmol/l at the bottomof that curve(figure).
Law and Wald are effectively suggesting that there is no non-dangerous blood pressure or cholesterol concentration and that,therefore, almost everyone in the Western world should be givensome kind of drug treatment. This is dangerous nonsense, and weshould not be afraid to sayso.

Interesting BP - another model

2007-06-13T20:45:00.001+12:00

Does anyone know where I can get my hands on BP percentile charts??

click here for above article

From the lancet

2007-06-13T20:09:00.000+12:00

Findings
Against the predictions of the linear logistic model, neither all-cause nor cardiovascular deaths depended on systolic blood pressure in a strictly increasing manner. The linear logistic model was rejected by the Framingham data. Instead, risk was independent of systolic blood pressure for all pressures lower than a threshold at the 70th percentile for a person of a given age and sex. Risk sharply increased with pressure higher than the 80th percentile. Since systolic blood pressure steadily increases with age, the threshold increases with age, but more rapidly in women than in men.
Intrepretation
The Framingham data contradict the concept that lower pressures imply lower risk and the idea that 140 mm Hg is a useful cut-off value for hypertension for all adults. There is an age-dependent and sex-dependent threshold for hypertension. A substantial proportion of the population who would currently be thought to be at increased risk are, therefore, at no increased risk.

Another what!!! Blood pressure this time

2007-06-13T19:47:00.000+12:00

Treating hypertension with guidelines in general practice

Their findings were that 'Shockingly, we have found that the Framingham data in no way supported the current paradigm to which they gave birth. In fact, these data actaully statistically reject the linear model.'

I think many GPs across the country will find resonance with Campbell and Murchie's views. Our otherwise well patients come to see us, have their blood pressure measured and many start on a medical treadmill of investigations, "treatments" and side effects.
These otherwise well people become ill - "I suffer with high blood pressure, Doctor".
They develop swollen ankles, lethargy, impotence, headaches, hot flushes, gout, electrolyte imbalances etc. They have blood tests and ECGs.
For all of the iatrogenic suffering, most people will not benefit from lowering of their blood pressure, or cholesterol for that matter.
The only people who are benefitting from this are the 1 in however many who are needed to treat, the researchers making a name and a career for themselves and of course the big drug companies.
But, I have to go now and meet my Quality Framework targets!

A book I shall be buying

2007-06-13T17:04:00.000+12:00

Neuroscientists have recently shown that biases
in thinking are built into the very way the
brain processes information--all brains... In
a study of people who were being monitored by
magnetic resonance imaging while they were
trying to process dissonant or consonant
information about George Bush or John Kerry,
researchers found that the reasoning areas of
the brain virtually shut down when participants
were confronted with dissonant information,
and the emotion circuits of the brain lit up
happily when consonance was restored. Researchers
also showed that reading information that goes
against your point of view can make you all the
more convinced that you are right.
--Carol Travis & Elliot Aronson (2007)

Mistakes Were Made (But Not by Me): Why We Justify
Foolish Beliefs, Bad Decisions, and Hurtful Acts

"Renowned social psychologists Carol Travis and Elliot Aronson take a compelling look into how the brain is wired for self-justification. When we make mistakes, we must calm the cognitive dissonance that jars our feelings of self-worth. And so we create fictions that absolve us of responsibility, restoring our belief that we are smart, moral, and right-a belief that often keeps us on a course that is dumb, immoral, and wrong."

Cervical cancer vaccine

2007-06-09T10:49:00.000+12:00

Judicial Watch Uncovers Three Deaths Relating to HPV Vaccine

Click here to view the Garadsil Related Deaths Reported to VAERS as of May 11, 2007

Click here to view the Vaccine Adverse Event Reporting System (VAERS) Reports as of May 11, 2007

Fainting schoolgirls wipe $A1bn off market value of Gardasil producer

Hysteria or what!

NNT - osteoporosis

2007-06-05T23:00:00.001+12:00

What is the NNT to prevent an osteoporotic fracture using Risedronate or Aledronate? Similarly using calcium and vitamin D? Is it necessary to give calcium supplements as well as risedronate or aledronate?

Great website - here - non drug company funded too

another NNT

NNT - how come some are so different

2007-06-04T20:27:00.000+12:00

There's another instructive way to consider the numbers. Suppose that 100 people with high cholesterol levels took statins. Of them, 93 wouldn't have had heart attacks anyway. Five people have heart attacks despite taking Pravachol. Only the remaining two out of the original 100 avoided a heart attack by taking the daily pills. In the end, 100 people needed to be treated to avoid two heart attacks during the study period—so, the number of people who must get the treatment for a single person to benefit is 50. This is known as the "number needed to treat - see rest of
article

Example

Sixty-year-old female with hypercholesterolaemia

The readily available New Zealand cardiovascular risk calculator can quantify absolute risk. With a blood pressure of 130/80, total cholesterol of 7.5 mmol/L, and an HDL cholesterol of 1.1 mmol/L, a non-smoking non-diabetic female has a fiveyear cardiovascular event risk of 7%. It is generally agreed that statins will reduce risk by a third. With treatment the five-year risk is thus about 5%.

When discussing the merit of treatment against the effort and potential adverse effects, consider the absolute risk reduction. About seven in 100 people will have an event in five years with no treatment, but if 100 take the statin for five years, five will have an event.

Beta blockers 20 people for five years
Asprin like drugs 50 people for five years
Statins 100 people for five years
take a look

Here's more on statins

Here's a good one with statins relating NNT to cardiovascular risk
same here NZ calculator

BP treatment 50 to 80 need to be treated for five years to prevent one death. And about 20 for five years to prevent one cardiovascular event.

Here's another list of NNTs
And another list of NNTs

Here Bandolier on NNT and here

some more statin ones in primary prevention and .

the authors affirm that statin therapy could reduce the absolute risk of coronary events during the next 4.3 years by 0.75% in low-risk patients (NNT= 133), by 1.63% (NNT=61) in moderate-risk patients and by 2.51% (NNT=40) in high-risk patients. They also conclude that it could be cost-effective in patients with an absolute risk over 20% of having a coronary event in the following 10 years. It would not be cost-effective in patients with a risk <10%,>
the study authors concluded that, in patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality

Reference:

Thavendiranathan P et al. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Nov 27;166(21):2307-13.

CVD interventions in the elderly

2007-06-04T20:03:00.000+12:00

Over 3.5 years and little benefit

Dem bones

2007-06-03T17:48:00.001+12:00

The use of an SSRI among persons aged 50 and older appears to be associated with an approximately two-fold increase in the risk of fragility fractures Richards, J.B., et al, Arch Intern Med 167:188, January 22, 2007

An increased risk of hip fractures with long-term use of PPIs among patients over the age of 50. Yang, Y.X., et al, JAMA 296(24):2947, December 27, 2006

Statins - yet again

2007-06-03T17:27:00.000+12:00

Abramson, J., et al, Lancet 369:168, January 20, 2007

These authors conclude that present lipid-lowering guidelines are not evidence-based.

Dr Malcom Kendrick essays

Whiplash

2007-06-02T09:10:00.001+12:00

Aggressive Care Might Delay Recovery

Renal failure and medication

2007-06-02T09:06:00.000+12:00

An over view - check it out.

glitazones - diabetes

2007-06-01T20:06:00.000+12:00

Drug Avandia

Statement by Sidney Wolfe, MD, Director of Health Research Group at Public Citizen

The New England Journal of Medicine study just released showing a 43 percent increase in heart attacks in people using Avandia should come as no surprise either to the Food and Drug Administration (FDA) or to Glaxo. In animal studies done prior to its approval, one of the most constant findings was damage to the heart, and within the first six years of approval there have been 689 cases of heart failure reported to the FDA in patients using the drug. In addition, there have been reports of anemia which, along with heart failure, increases the risk for a heart attack.

other side effects

principal unwanted effects include weight gain (about 5%, or 3.5 kg over 6 months)
water retention and leg oedema (in about 5%)
dizziness, headache, fatigue, and hypoglycaemia (only when used in combination with a sulphonylurea) has also been reported with both drugs in combination therapy
other reported effects with pioglitazone include visual disturbances, arthralgia, impotence, flatulence, proteinuria, haematuria and with rosiglitazone, gastrointestinal disturbances, rash, paraesthesia, dyspnoea, rash, alopecia and thrombocytopaenia
since rosiglitazone and pioglitazone can cause fluid retention, which may exacerbate or precipitate heart failure, these drugs should be avoided in patients with any current, or history of heart failure - note that all patients taking either glitazone should be monitored for features of heart failure
macular oedema - cases of new onset and worsening macular oedema have been reported in patients treated with rosiglitazone. It has been reported that "in some cases, macular oedema resolved or improved following discontinuation of therapy and in one case macular odema resolved after dose reduction "(2)
cardiovascular risk - there has been evidence from a meta-analysis concerning the use of rosiglitazone and increased risk of myocardial infarction (3) - for more detail see linked item

Here is some debate about the heart attack issue

My thoughts - it's not that effective so why bother with it at all!!!

ACE Diuretic, NSAIDS and renail failure

2007-06-01T19:48:00.000+12:00

Beware the triple whammy!

ADRAC has previously warned prescribers about the 'triple whammy' - the combination of an ACE inhibitor (ACEI) or an angiotensin II receptor antagonist (A2RA), a diuretic and an NSAID (including a COX-2 selective NSAID), which may predispose vulnerable patients to renal failure.^1,2,3 Risk factors include advanced age, pre-existing renal impairment and dehydration. In 2005, ADRAC received 21 reports of renal failure in patients who were exposed to the triple whammy. In a number of cases, precipitating factors included an acute illness, dehydration, digoxin toxicity or the recent addition of an NSAID to a patient already on an ACEI or an A2RA and a diuretic.

clozapine

2007-06-01T19:45:00.001+12:00

Clozapine and myocarditis

Clozapine, marketed in Australia since 1993, is an effective antipsychotic for the management of treatment-resistant schizophrenia. All patients taking clozapine are enrolled in a registry and monitored regularly, primarily to detect the development of neutropenia and agranulocytosis.

A range of cardiac disorders has been associated with the use of clozapine, the most serious being myocarditis and cardiomyopathy. A boxed warning alerting prescribers to these reactions is included in the Product Information for clozapine.

Fat drug

2007-06-01T17:23:00.000+12:00

- The Diet Drug Orlistat (XENICAL) and Gallstones

June 2007
Yet another problem has been detected with this diet drug whose approval we opposed and that we have been attempting to get banned. The FDA found 37 cases of gall stones in patients using orlistat. This, in addition to inhibiting the absorption of important vitamins such as A, D, E and K as well as evidence that the drug can cause pre-cancerous abnormalities in the colon of animals, further emphasizes why this barely effective drug should not be used, either in the prescription version called Xenical or the about-to-appear over-the-counter version, Alli.

Macular degeration - wet

2007-05-31T23:12:00.000+12:00

Treatment options

The first point of contact for treatment options should be with your eye specialist. In many cases this will be a retinal
specialist. You should always discuss any concerns, questions or information you have obtained with your specialist. The specialist is in the best position to advise you on your treatment options.

Wet Macular Degeneration (MD) occurs when abnormal blood vessels grow and leak into the retina. This process is called neo-vascularization (CNV). Neo = new and vascularisation = vessel formation.

There are currently two sections of treatments available for people with wet MD:

*
Treatments proven to be effective by controlled trials published in peer review journals
*
Experimental treatments

The treatments are not curative and aim to keep the best vision for as long as possible.

Vitamins and zinc for wet macular

Here is an eye doc's blog on AMD.

Oxygen - too much of a good thing

2007-05-27T08:02:00.000+12:00

A new study suggests that pumping pure oxygen into patients' noses and mouths during a stroke or other medical emergency may exacerbate rather than reduce potential brain damage.

numbers needed to treat

2007-05-26T16:32:00.000+12:00

Here are some examples of Numbers Needed to Treat, found at the Bandolier web site (http://www.jr2.ox.ac.uk/bandolier/index.html).

Prevention of post-operative vomiting using Droperidol, NNT=4.4. For every four or five surgery patients treated with Droperidol, you will see one less vomiting incident on average.

Prevention of infection from dog bites using antibiotics, NNT=16. For every 16 dog bites treated with antibiotics, you would see one fewer infection on average.

Primary prevention of stroke using a daily low dose of aspirin for one year, NNT=102. For every hundred patient years of treatment with aspirin, you will see one fewer stroke on average.

Here's another example from the British Medical Journal (Freemantle 1999: 318(7200); 1730-1737). Prevention of cardiac death using beta blockers among patients with previous myocardial infarction, NNT=42. For every 42 patients treated for two years with beta blockers, you would see one fewer death. This is superior to treatment with antiplatelet agents (NNT=153), Statins (NNT=94), or Warfarin (NNT=63), but not as effective as thrombolysis and aspirin for 4 weeks (NNT=24).

Antipsychotics

2007-05-26T13:12:00.001+12:00

Diabetes, hypertension, hyperprolactinaemia
Diabetes and Antipsychotic Drugs (Nov 2004)
Atypical Antipsychotics May Cause Hypertension (Apr 2003)
Hyperprolactinaemia with Antipsychotics (

2007-05-26T13:05:00.000+12:00

Psychiatric Drugs: Chemical Warfare on Humans - interview with Robert Whitaker

Drug alert

2007-05-26T12:25:00.001+12:00

Watching Briefs (Nov 2006)

Clozapine - fatal constipation

2007-05-26T12:22:00.000+12:00

Clozapine is an atypical antipsychotic that is effective for treatment-resistant schizophrenia. It causes agranulocytosis in up to 1% of patients¹ and regular monitoring of neutrophil counts is mandatory throughout treatment. In New Zealand one death from agranulocytosis has been reported to the IMMP. In contrast, four deaths from complications of severe constipation have been reported. This article reminds health professionals that the gastrointestinal (GI) effects of clozapine are potentially serious. Awareness of this issue may prevent life-threatening complications.

Diastolic blood pressure below 90?

2007-05-26T12:13:00.000+12:00

Conclusion

The HOT study does not provide sufficient evidence of the benefits of intensive treatment of blood pressure (that is, reducing diastolic pressures below 90 mmHg) in patients with hypertension. However, in the original sub-group analysis of the HOT study, which looked at the results in patients with diabetes, there are differences in the outcomes between treatment groups. Patients with diabetes in the lowest target blood pressure group had significantly lower rates of cardiovascular events. Total mortality was also decreased.

Sticky platelets

2007-05-26T11:36:00.000+12:00

Antiplatelet Chemoprevention of Occlusive Vascular Events and Death

Conclusions

SECONDARY PREVENTION:

ASA, 80 -325 mg/day, is proven effective for the prevention of vascular occlusive events for patients with established disease. There is little evidence of benefit beyond a maximum dose of ASA of 325 mg/day.
Other antiplatelet drugs should be used for patients allergic to or intolerant of ASA.
Patient characteristics, benefits, harm and cost should be considered when selecting an agent other than ASA.
Combination of ASA with other antiplatelet agents requires further study.

PRIMARY PREVENTION:

Benefit of platelet prevention has not been shown to exceed harm in patients without proven vascular occlusive disease.

2007-05-23T00:04:00.000+12:00

Stable angina - surgery or pills

Middle ear effusion - grommets

2007-05-22T23:08:00.000+12:00

In most studies, tubes improved hearing in the short term (about 9 dB at six months and 4 dB at two years). The benefit was attenuated in children who also underwent adenoidectomy (3 to 4 dB at six months and no difference at two years). Differences in speech or language development were minimal or nonexistent. Studies on the adverse effects of tubes are limited but suggest that children given tubes may experience a small long-term hearing loss (mean of 2 to 7 dB) compared with children who have a similar severity of OME but are not given tubes.

Yeah!!!

HRT - Cochrane review

2007-05-22T23:02:00.000+12:00

Evidence-Based Answer

Relatively healthy women taking combined continuous hormone therapy have higher risks of myocardial infarction and venous thromboembolism after one year, stroke after three years, and breast cancer after five years. In women who take hormone therapy continuously for five years, there is a lower incidence of fractures and colon cancer. Although it may be relatively safe and effective for short-term symptom control, hormone therapy should not be given routinely for prevention or chronic disease management.1

Stents and things

2007-05-22T22:57:00.000+12:00

Early Invasive Therapy or Conservative Management for Unstable Angina or NSTEMI?

The authors conclude that an early invasive strategy is preferable to a conservative management strategy in the treatment of patients with UA or NSTEMI; however, the absolute difference between strategies in long-term mortality was not large. Forty-three people would need to be treated with an early invasive strategy to prevent one death at two to five years (i.e., number needed to treat [NNT] = 43), and a comparable number of patients will experience bleeding or procedure-related myocardial infarction (number needed to harm [NNH] = 36 and 35, respectively). However, there was a clear benefit with early invasive treatment in preventing rehospitalization during the first year (NNT = 10).

Patient handouts

2007-05-22T22:32:00.001+12:00

Diabetes • Heart Disease • Asthma • Allergies • Mental Health • Stomach & Intestinal Problems • Mono • Skin Problems • Pain • Cancer • STIs/HIV • More

A B C D E F G H I J K L M N O P Q R S T U V W X Y

Hypertension - aspirin

2007-05-22T21:15:00.000+12:00

Since the magnitude of benefit from the reduction in cardiovascular events was similar to the magnitude of harm of an increased risk of haemorrhagic events, the Cochrane review concluded that antiplatelet therapy with aspirin cannot be recommended in uncomplicated hypertension as primary prevention per se due to the narrow balance between benefit and harm.

Hypertension -numbers needed to treat

2007-05-22T19:43:00.000+12:00

Treating newly diagnosed asymptomatic hypertension

In women ages 30 to 54 years (79% white), hypertension treatment results in a 41% risk reduction in fatal and nonfatal cerebrovascular events (95% CI 8-63%, 5 year NNT 264), and a 27% risk reduction in fatal and nonfatal cardiovascular events (95% CI 4-44%, 5 year NNT 259).

QT prolongation - drugs

2007-05-21T21:22:00.000+12:00

Drugs that Prolong the QT Interval and/or Induce Torsades de Pointes Ventricular Arrhythmia

statin or diet

2007-05-20T15:48:00.000+12:00

MN: And people who have had a heart attack?

JA: Statins are definitely helpful for people who have already had a heart attack. Still, the Lyon Diet Heart Study shows how much more effective a healthy diet is in reducing the risk of heart attack for these folks. The participants were randomly assigned to receive counseling about a Mediterranean-style diet (see end of article) or a standard post-heart attack diet. Those who went on the Mediterranean-style diet developed 72% less heart disease than those in the control group. There was also a 56% lower death rate and 61% less cancer than the people in the control group. Simply eating a Mediterranean-style diet is nearly three times more effective at preventing recurrent heart disease and death in post-heart attack patients than is taking a statin. Even more surprising, those on the Mediterranean-style diet did not have lower cholesterol than those eating the standard post-heart attack diet. So when your doctor tells you to get your cholesterol down…keep that in mind.

Google overdosedamerica or centre for medical consumer

Dash Diet - what to expect.

How can you assist a motivated patient?
Patients can obtain information about the DASH diets at this website: www.nhlbi.nih.gov/health/public/heart/hbp/dash Collecting 24-hour urine for potassium and sodium establishes where the patient is at baseline; subjects eating an average North American diet excrete approximately 40 mmol of potassium per day and 150 mmol of sodium per day. The potassium target for the DASH diet is a 24-hour urinary potassium of 80 mmol. The sodium target for a low-sodium diet is a 24-hour urinary sodium of 50-100 mmol. These tests cost $1.49 each in BC.

Statins - the elderly

2007-05-20T15:44:00.000+12:00

MN: That one trial with people over 70, called PROSPER (PROspective Study of Pravastatin in Elderly at Risk), is often misrepresented.

JA: This trial clearly showed the limited benefit of statins in the elderly. For those who already have cardiovascular disease, taking a statin reduces the risk of heart attack or cardiac death. But it also showed that people in this age range who are at increased risk of, but do not have, cardiovascular disease do not benefit from taking a statin. Importantly, the study also found that at four years, there was one extra new cancer for every 70 people taking a statin. No reduced risk of stroke and no benefit for people without cardiovascular disease and an increased risk of cancer, yet millions of elderly Americans without heart disease or diabetes are taking these drugs because they and their doctors are misled into believing that clinical trials have shown that statins are beneficial.

naughty Naughty nnNNNaughty!!!!

2007-05-16T19:32:00.000+12:00

In a Jan. 17, 2003, warning letter from the Food and Drug Administration to the company concerning illegal advertising of OxyContin ............... overstating the safety profile .................. not referring to the large number of fatalities ................ overselling the benefits.

On May 10, 2007, Purdue was ordered to pay $634 million in criminal and civil penalties - including guilty pleas by three current and former Purdue Frederick executives - for misbranding the potent narcotic OxyContin. This ruling sends an important message to the drug industry that this kind of malicious, death-dealing behavior will not be tolerated.

Should women be offered cholesterol lowering drugs to prevent cardiovascular disease?

2007-05-13T17:09:00.000+12:00

Yes!

NO!

MN: Whenever I write about statins, I get calls from readers that indicate many are misled about their level of risk. Typical is the healthy woman over the age of 65 pressured to take statins by her doctor who says that she is at high risk for a heart attack solely because of age and high cholesterol.

JA: 1) The evidence shows that the higher her cholesterol, the longer she will live; 2) no trial shows that statin therapy will benefit her; 3) people over 65 who exercise routinely, eat a Mediterranean-style diet, don’t smoke, drink moderately, will have a 60% lower rate of death than the people who don’t do these things.

Black box warning antidepressants

2007-05-12T10:20:00.000+12:00

Depression is the real killer, not antidepressants, say commentators

How effective are they anyway

counter argument

Radiation - too much of a good thing

2007-05-12T10:14:00.000+12:00

It is time that medicine inall specialties became aware of the epidemic of exposure todiagnostic radiation in patients and did something about it.

Statins - impotence in men?

2007-05-12T10:03:00.000+12:00

.......Information of new side effects are also slow to appear. In a study of 82 male patients with heart disease sponsored by Pfizer, 20 % became more or less impotent already after six months of statin treatment.⁶ But although this observation was published February 2006 nothing is mentioned on Pfizer´s homepage for atorvastatin............

hypertension

2007-05-05T11:10:00.000+12:00

Mild Hypertension - An approach to using evidence in the decision making process

The key pooled outcomes from these 5 trials reveal the following: Would you take the pill?
1. Total mortality, RR 0.95 [0.71 - 1.11] - no real difference between taking or not aking.
2. Total serious adverse events were not reported in any of the trials.
3. Total cardiovascular events (fatal and non-fatal strokes plus fatal and non-fatal coronary heart disease) were reduced from 4.0% to 3.2%, RR 0.81 [0.71 - 0.92], ARR 0.8%,
Number Needed to Treat is 125 people for 5 years for one person to benefit.
4. Withdrawals due to adverse events, RR 4.8 [4.2 - 5.6], ARI 9%, NNH 11 for 5 years.

You now feel you are in a position to explain the benefits and harms to your patient.

Treatment of Hypertension

Aiming for a target diastolic BP of lower than 90 mm Hg provides no therapeutic advantage for most hypertensive patients.

The two groups with lower bp might be expected to have fewer cardiovascular events but this was not seen

ALLHAT STUDY

Total mortality, coronary heart disease and end-stage renal disease are similar for first-line thiazides (diuretic), CCBs (Calcium channel blockers) and ACEIs (Angiotensin-Converting Enzyme).
Heart failure is increased with first-line CCBs as compared to thiazides or ACEIs.
Stroke is reduced with first-line thiazides as compared to ACEIs.
BP control and tolerability are better with first-line thiazides as compared to ACEIs.
Cost is substantially less for thiazides as compared to beta-blockers, ACEIs, CCBs, alpha blockers, and angiotensin receptor blockers.

Drugs of Choice in the Treatment of Hypertension

After review of the long term hypertension studies, including the epidemiologic and randomized placebo controlled drug trials, certain clinically important facts stand out:

Risk of cardiovascular events correlates better with systolic than diastolic blood pressure.(1)
Risk correlates better with blood pressures taken outside the doctor's office than with office blood pressures.(2)
Blood pressure consistently decreases with placebo treatment (10/8 mm Hg).(3)
The average additional blood pressure fall in the active treatment group is modest (11/6 mm Hg).(3), (4)
The average blood pressure fall with treatment in trials using low doses of just one drug (7-9.5/46.5mm Hg) (5), (6) is similar to that obtained from an overview of trials using high doses of multiple drugs (11/6 mm Hg).(3), (4)

These facts suggest the following ways to assist in managing your patients with hypertension:

Put more emphasis on systolic and home blood pressures when making treatment decisions.
Appreciate that some of the blood pressure lowering effect seen in the office is due to the placebo effect. In other words, no matter what you are prescribing, it is likely to appear efficacious.
Realize that pushing the dose seldom improves the antihypertensive effect. Likewise, the dose can frequently be lowered in patients receiving high doses of antihypertensive drugs without changing the antihypertensive effect.

Can blood pressure be lowered by a change in diet? Evidence from the DASH trials

Substantial BP lowering can be achieved by a reduced dietary sodium intake, the DASH diet, or a combination of the two. This approach is applicable to those patients consuming an average North American diet who are motivated to make a change.

Atenolol

If you on this maybe you'd be better off on something else

Statins - the elderly

2007-05-04T16:18:00.000+12:00

No studies have examined the impact of statins in randomized trials in those over age 75. Epidemiological studies show higher cholesterol to be protective, rather than harmful, in this age group, so it cannot be assumed that lowering cholesterol confers benefit exceeding risk. Low cholesterol may be a risk factor for heart arrhythmias, which are the leading cause of death if heart attacks occur; and in the elderly, a heart rhythm abnormality called atrial fibrillation, that may be increased with low cholesterol, is a particularly important risk factor for stroke in the older elderly. It is possible that there are subgroups of those over age 75 for whom statins confer benefit exceeding risk, but this has never been demonstrated. This would most likely be the case in persons at very high risk of death from heart disease, who are at comparatively low risk for other illness and injury.

Remember that extra death from cancer per year after four years in the elderly!!

Statins - women

2007-05-04T16:15:00.000+12:00

As of this writing, no study has shown statins or any other cholesterol drugs to lower overall mortality in women; and epidemiologically, cholesterol in women does not have the same relation to mortality as in men. Although higher cholesterol is linked to a higher rate of heart attacks per se, it is not linked to overall cardiovascular death or to overall death; indeed, lower cholesterol is linked to a slightly higher risk in some studies. Consistent with this, there is a decided reduction in heart attacks in women with statins, but the death rate overall -- or even cardiovascular death rate - has not been shown to be reduced. It is possible that there are subgroups of women for whom statins confer benefit exceeding risk, but this has never been demonstrated.

Diet or statins or both?

2007-05-04T16:02:00.000+12:00

The Lyon Diet Heart Study

The participants were randomly assigned to receive counseling about a Mediterranean-style diet (see end of article) or a standard post-heart attack diet. Those who went on the Mediterranean-style diet developed 72% less heart disease than those in the control group. There was also a 56% lower death rate and 61% less cancer than the people in the control group. Simply eating a Mediterranean-style diet is nearly three times more effective at preventing recurrent heart disease and death in post-heart attack patients than is taking a statin. Even more surprising, those on the Mediterranean-style diet did not have lower cholesterol than those eating the standard post-heart attack diet. So when your doctor tells you to get your cholesterol down…keep that in mind.

What!! Doesn't this blow a wee hole in the whole cholesterol theory??

Yup statins again - primary prevention

2007-05-04T15:08:00.000+12:00

Ask your doc is this lipex for primary or secondary prevention?

Primary prevention

If cardiovascular (SAEs) serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3 to 5 years to prevent one myocardial infarction or stroke.
This cardiovascular benefit is not reflected in 2 measures of overall health impact, total mortality and total serious adverse events.
Therefore, statins have not been shown to provide an overall health benefit in primary prevention trials.

Secondary prevention

These 4 trials reconfirm the benefit of statins for patients with elevated cholesterol and coronary disease and expand the benefit to patients with clinically evident occlusive coronary, cerebral or peripheral vascular disease and a total cholesterol >3.5 mM. Despite the lack of reporting of total SAEs in these trials, one measure of overall health benefit, total mortality, was reduced, pooled RR 0.84 [0.79–0.88], ARR 2.1%, NNT 48 for 3 to 5 years.

Note the lack of reporting of SAEs! Why not? Makes me suspicious.

Note that most of these studies take place only over a few years - notoriously the harms take years to surface.

Statins have been promoted as having few side effects - we shall see. Here's a place keeping tabs on side effects. This site doesn't mention the risk of cancer in the elderly.

In 70 and above year olds without heart disease statin therapy did not reduce risk of stroke or heart attack. It did increase their risk of cancer. By the fourth year there is one extra cancer for every 100 elderly people taking statin per year.

So 48 people have to keep taking the pill for 3-5 years for one person to benefit! Probably worth doing.

But what about diet and exercise?
What about women?
What about the elderly?