31 March 2008

Let Me Tell You Why Vytorin Was So Popular (Even Though It Doesn't Lower Heart Disease)

This is one of the biggest problems in medicine today and why some class-action lawsuits are justified.  Working as a nurse in both the military and civilian health systems, I saw drug company representatives often.  Very often.  They schmoozed and courted doctors, pharmacists, and nurses.  They always had a ton of goodies (pens, pencils, calculators, clocks, notepaper, keychains, books, calendars, etc...) along with sponsoring "teaching seminars".  These educational opportunities were full lunches and dinners little more than live infomercials for whatever the drug-of-the-moment was.

But doctors were stunned to learn that Vytorin failed to improve heart disease even though it worked as intended to reduce three key risk factors.

Not surprisingly, this medicine would frequently be added to the formulary soon after.  The military system had to put a draconian ethic system in place because the problem spiraled out of control.  Every new drug to hit the market was making its way into the military treatment facilities, no matter what it cost.  Even after these new rules were in place, it was a long time before pharmacists and doctors started having trouble working around the restrictions.  One pharmacist I knew made sure the drug reps knew exactly how much they could spend per person without running afoul of the regulations... this was down to the penny.  It was ten times worse in the civilian hospitals I worked.

The study was closely watched because Zetia and Vytorin have racked up $5 billion in sales despite limited proof of benefit. Two Congressional panels launched probes into why it took drugmakers nearly two years after the study's completion to release results.

I'm all for tort-reform but people need to remember why it became popular in the first place.

"It will be 2012 — ten years after the drug was introduced — before we know the answer," said Dr. Steven Nissen, a Cleveland Clinic cardiologist who has no role in the studies and has criticized the drugmakers over the one reported Sunday.


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29 March 2008

Faith Healing

What do you do when the religious beliefs of parents endanger their children?  I am a strong supporter of parental rights and the freedom to practice religion, but kids have rights too.

Madeline Neumann, 11, died Sunday the Weston home of an undiagnosed but treatable form of diabetes as her parents, Dale and Leilani Neumann, prayed for her to get better. Her mother said she never expected her daughter, whom she called Kara, to die.

The family believes in the Bible, which says healing comes from God, Leilani Neumann said.

If they believe in God and the Bible, where do they think medical knowledge comes from?  If a child breaks a bone, is it a sin to put a cast on?  The parents have three other children who are now staying with another relative while this is being investigated.  I hope the investigation is thorough, but that won't bring Kara back. 


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28 March 2008

Sound Monitors Help Premature Babies

I love when simple things are used in new ways that make you say, "Dang! I should have thought of that!"  This article just started me wondering about other technologies that have been around for decades might be useful in unique ways.

As decibels rise, the colors on the new monitoring system change from green to yellow to red, hushing chatty parents or doctors so the babies get the rest they need to develop.

It will be interesting to see some longevity studies on the efficacy of these monitors.

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17 March 2008

... You Might Be A Nurse

My son is entering Nursing School this summer and I wanted to share these with him... most of these have been around a while so attribution is impossible.  They're a takeoff on Jeff Foxworthy's "You Might Be a Redneck" schtick.

If you've ever spent more money on a stethoscope than a video camera... you might be a nurse.

If you mumble to yourself, "Great veins!" when looking at the arms of complete strangers... you might be a nurse.

If you believe that the more equipment a doctor carries, the newer they are... you might be a nurse.

If you wash your hands before going to the bathroom... you might be a nurse.

If you ever get scared when a child is quiet... you might be a nurse.

If you've ever been tempted to choke the life out of someone who thinks the night shift is boring because, "All the patients do is sleep"... you might be a nurse.
more...

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12 March 2008

Restoring Eyesight?

This is absolutely amazing and I hope it's as close as they make it appear.  If they can get successful animal testing done this summer, a couple of years before it's approved for humans is not out of the question.

My oldest daughter is blind in one eye and we were told as recently as last year that it wasn't something they could fix.  The doctor didn't even mention this, so I don't think the research is very common knowledge.  Our daughter's very good eye surgeon and I had discussed what advances were being made, and what more needed to happen, before we could reasonably hope my daughter's vision might be restored.  According to what we looked at, the medical science seemed to be between 10 and 15 years away, but now it's time to make another appointment I think.  Just to talk.



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08 March 2008

New Treatments for Alzheimer's

I used to work with patients suffering from Alzheimer's and other demetias when I was a clinical instructor in the Army.  At the time, Aricept was one of the first drugs specifically labeled for treatment of Alzheimer's.  Since then, it's not surprising that many advances have been made, so as I read this article was very surprised to see this:

Still, some controversy exists among experts as to what actually causes Alzheimer’s. Recent breakthrough research raises the question that Alzheimer’s could be a third form of diabetes. [emphasis mine]

I had never considered this but it makes a lot of sense.  We already know that diabetes can have many chronic and potentially fatal complications.  Cardiovascular disease, impotence, nerve damage, diabetic retinopathy... the list goes on and on.  What most people don't realize about diabetes is that it's really about insulin, not sugar.  I'm going to simplify this quite a bit, but it's pretty representative of what happens.  Insulin is what breaks down sugar in the blood (glucose).

When your pancreas doesn't produce enough insulin, that's Type I (or Insulin Dependent Diabetes Mellitus -- IDDM).  When your cells resist insulin and prevent it from working even though you have enough, that's Type 2 (or Non-Insulin Dependent Diabetes Mellitus -- NIDDM).  It's really that simple... diabetics either don't make the insulin they need, or something in their cells keeps the insulin from working.

Alzheimer's is generally considered to be caused by the formation of amyloid plaques and tangles breaking down the brain's nerve cells.  Now, how can problems with insulin be related to Alzheimer's?  My guess (and it's only my guess, no research or anything to back it up.  Just thoughts sparked by the linked article) is that if insulin is interfering with the transport or function of glucose (blood sugar) past the blood-brain barrier, it could possibly create the amyloid plaques and tangles assumed to cause Alzheimer's.  This could be either through direct accumulation of waste sugars, damage from excess sugars in the vessels (kind of like creating scar tissue), or something else that I haven't considered.

The bottom line is that this will be very interesting research to watch in the future because curing one might end up meaning curing both.  That would be fantastic.

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