Showing posts with label save. Show all posts
Showing posts with label save. Show all posts
Do Cholesterol Lowering Drugs Save Lives
Thursday, May 22, 2014
If you read my last post about cholesterol-lowering drugs, then you understand some of the problems that can arise from their use. Statins can produce some nasty side effects. But side effects aside, statins save lives right? I mean, doctors prescribe them to just about everyone, they must be effective. Not quite... the story is not as simple as it may seem.
When looking at the statin drug clinical trials, its important to keep a few things in mind. Firstly, and most importantly... total mortality is more important than heart disease mortality. If a drug prevents you from dying of heart disease but doesnt affect your chances of dying in general, then that drug is not worth taking. Whats most important is whether or not the drug will extend your life. Secondly, you must consider that different groups of people may respond differently to the drug. Women, middle-aged men, the elderly, and those with preexisting heart disease may all respond differently to treatment.
Id like to begin by talking about women... both because I like women, and because they dont respond well to statins. Although many statin studies notoriously neglect to reveal the all-cause death data for women, there are a few studies that do. Check out the Scandinavian Simvastatin Survivial Study (4S), which was one of the most positive trials to date. The big pharma folks must have been partying it up when this one came out. This was a secondary prevention trial, meaning that participants all had pre-existing heart disease (previous heart attack or angina). For future erence, a primary prevention trial would be an experiment in which the participants did not have pre-existing heart disease. So, half of them took simvastatin and half of them took a placebo. The results were great across the board: heart attack numbers were reduced, along with deaths from heart disease and all-cause mortality. But there was one group that clearly didnt benefit: women. Over the duration of the 5.4 years of the trial, 27 (6.6%) of the women taking the statin died, while only 25 (6%) of the women taking the placebo died. So despite the rest of the data, which was very supportive of statins, there was actually a slight increased risk of death in women from taking the statin. As youll soon see, this finding is consistent throughout all of the statin trials, yet it is completely ignored by mainstream medicine. These drugs simply dont work for women.
Now, men are a bit of a different story. Its important to split men up into two distinct groups: those with diagnosed heart disease (previous heart attack or angina), and those without diagnosed heart disease. In those without heart disease, statins appear to be largely ineffective. Both the University of British Columbia and Dr. Graham Jackson in the UK have published review articles looking at many of the primary prevention statin trials. These were both reviews of the existing research, and they did not pick and choose studies that would support one side or the other. Heres a key statistic from the UBC paper: "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." And heres one from Dr. Jacksons study: "Long term use of statins for primary prevention of heart disease produced a 1% greater risk of death over ten years versus placebo when the result of all the big controlled trials reported before 2000 were combined." Although both studies showed reduction of cardiovascular deaths in those taking statins, overall deaths were either the same or higher. Oh, and they also found zero effect on cardiovascular deaths in women. Sounds like statins arent so effective in those without pre-existing heart disease.
And Ive got more. In 2005, a study called ASCOT-LLA, which studied Lipitor on high blood pressure patients, was stopped early due to the supposed "massive" reduction in cardiovascular deaths experienced by the Lipitor group. The researchers considered the benefits so great that it was unethical to continue to deprive the placebo group of proper treatment. This study is considered to be one of those landmark trials that proved once and for all the life-saving benefits of statins. Well, lets look at the data... youll have to click to enlarge it.
In that first set of data, Id like to draw your attention to the "all-cause mortality" graph in the bottom right. See that vertical line there that Ive drawn in? Thats a little trick I learned from Dr. Malcolm Kendrick in his book The Great Cholesterol Con. The reason that line is drawn in there is because the trial ended at 3.3 years. The graphs, however, show data until 3.5 years. If you look closely at the graph, at 3.3 years there is almost no difference between the Lipitor group and the control group, but for the last 0.2 years of the study, the two lines begin to suddenly separate. WTF mate? How does one acquire data for a study after the study has ended? Something seems fishy to me... tampering of evidence perhaps? No way to know for sure, but I can say with certainty that there was no reason to shut down this study early. Theres virtually no difference in the all-cause mortality data. Oh, and that second graph... thats showing the effectiveness of Lipitor on cardiovascular mortality (note: NOT all-cause mortality). Notice women in this trial had an increased risk of dying from heart disease on the drug.
To sum up the statin drug data, heres a convenient table copied again from Dr. Malcolm Kendrick:
You can see here that the 4S trial, which I discussed earlier, was overall very supportive of statin use. This trial was purely a secondary prevention trial. And I must admit that statins do appear to save lives in men with previous heart disease. But that is the ONLY group for which they save lives. Purely primary prevention trials, like EXCEL, actually showed in increase in all-cause death on statins. And then there are trials like WOSCOPS, which was a mix of primary and secondary prevention, and those trials typically yield results somewhere in the middle of the extremes. Even in the most positive statin data for those with pre-existing heart disease, however, the results are really underwhelming. You would think that with all the hype surrounding these supposed "life-saving" drugs, the data would be a little stronger. Even if you do have pre-existing heart disease, and are a man, you can only expect about a 3% reduction in the chance of dying over the next several years. That is just unimpressive to me.
So despite the relentless pushing of these drugs by big pharmaceutical companies, mainstream doctors, and my Anatomy and Physiology professor, caul examination of the data shows a surprising lack of evidence to support their use. Statins decrease the risk of dying of heart disease; thats good. But they dont decrease the risk of dying overall in the majority of the population; thats bad. So then, if heart disease deaths are decreasing but overall deaths are not, statins must be increasing the risk that youll die of something other than heart disease. Im even going to go as far as to say that they cause these non-cardiovascular-related deaths. Unfortunately, most studies fail to specify exactly what these non-cardiovascular deaths are, but take a look at my previous post for an idea. If youre a woman, statins wont even reduce your risk for heart disease, and they actually increase your risk of dying overall. The only population for which statins can save lives is men with pre-existing heart disease, which is less than 5% of the population. If youre one of those people, take your statin if youre so inclined. But if youre anyone else, especially a woman, you are barking up the wrong tree.
When looking at the statin drug clinical trials, its important to keep a few things in mind. Firstly, and most importantly... total mortality is more important than heart disease mortality. If a drug prevents you from dying of heart disease but doesnt affect your chances of dying in general, then that drug is not worth taking. Whats most important is whether or not the drug will extend your life. Secondly, you must consider that different groups of people may respond differently to the drug. Women, middle-aged men, the elderly, and those with preexisting heart disease may all respond differently to treatment.
Id like to begin by talking about women... both because I like women, and because they dont respond well to statins. Although many statin studies notoriously neglect to reveal the all-cause death data for women, there are a few studies that do. Check out the Scandinavian Simvastatin Survivial Study (4S), which was one of the most positive trials to date. The big pharma folks must have been partying it up when this one came out. This was a secondary prevention trial, meaning that participants all had pre-existing heart disease (previous heart attack or angina). For future erence, a primary prevention trial would be an experiment in which the participants did not have pre-existing heart disease. So, half of them took simvastatin and half of them took a placebo. The results were great across the board: heart attack numbers were reduced, along with deaths from heart disease and all-cause mortality. But there was one group that clearly didnt benefit: women. Over the duration of the 5.4 years of the trial, 27 (6.6%) of the women taking the statin died, while only 25 (6%) of the women taking the placebo died. So despite the rest of the data, which was very supportive of statins, there was actually a slight increased risk of death in women from taking the statin. As youll soon see, this finding is consistent throughout all of the statin trials, yet it is completely ignored by mainstream medicine. These drugs simply dont work for women.
Now, men are a bit of a different story. Its important to split men up into two distinct groups: those with diagnosed heart disease (previous heart attack or angina), and those without diagnosed heart disease. In those without heart disease, statins appear to be largely ineffective. Both the University of British Columbia and Dr. Graham Jackson in the UK have published review articles looking at many of the primary prevention statin trials. These were both reviews of the existing research, and they did not pick and choose studies that would support one side or the other. Heres a key statistic from the UBC paper: "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." And heres one from Dr. Jacksons study: "Long term use of statins for primary prevention of heart disease produced a 1% greater risk of death over ten years versus placebo when the result of all the big controlled trials reported before 2000 were combined." Although both studies showed reduction of cardiovascular deaths in those taking statins, overall deaths were either the same or higher. Oh, and they also found zero effect on cardiovascular deaths in women. Sounds like statins arent so effective in those without pre-existing heart disease.
And Ive got more. In 2005, a study called ASCOT-LLA, which studied Lipitor on high blood pressure patients, was stopped early due to the supposed "massive" reduction in cardiovascular deaths experienced by the Lipitor group. The researchers considered the benefits so great that it was unethical to continue to deprive the placebo group of proper treatment. This study is considered to be one of those landmark trials that proved once and for all the life-saving benefits of statins. Well, lets look at the data... youll have to click to enlarge it.
In that first set of data, Id like to draw your attention to the "all-cause mortality" graph in the bottom right. See that vertical line there that Ive drawn in? Thats a little trick I learned from Dr. Malcolm Kendrick in his book The Great Cholesterol Con. The reason that line is drawn in there is because the trial ended at 3.3 years. The graphs, however, show data until 3.5 years. If you look closely at the graph, at 3.3 years there is almost no difference between the Lipitor group and the control group, but for the last 0.2 years of the study, the two lines begin to suddenly separate. WTF mate? How does one acquire data for a study after the study has ended? Something seems fishy to me... tampering of evidence perhaps? No way to know for sure, but I can say with certainty that there was no reason to shut down this study early. Theres virtually no difference in the all-cause mortality data. Oh, and that second graph... thats showing the effectiveness of Lipitor on cardiovascular mortality (note: NOT all-cause mortality). Notice women in this trial had an increased risk of dying from heart disease on the drug.
To sum up the statin drug data, heres a convenient table copied again from Dr. Malcolm Kendrick:
You can see here that the 4S trial, which I discussed earlier, was overall very supportive of statin use. This trial was purely a secondary prevention trial. And I must admit that statins do appear to save lives in men with previous heart disease. But that is the ONLY group for which they save lives. Purely primary prevention trials, like EXCEL, actually showed in increase in all-cause death on statins. And then there are trials like WOSCOPS, which was a mix of primary and secondary prevention, and those trials typically yield results somewhere in the middle of the extremes. Even in the most positive statin data for those with pre-existing heart disease, however, the results are really underwhelming. You would think that with all the hype surrounding these supposed "life-saving" drugs, the data would be a little stronger. Even if you do have pre-existing heart disease, and are a man, you can only expect about a 3% reduction in the chance of dying over the next several years. That is just unimpressive to me.
So despite the relentless pushing of these drugs by big pharmaceutical companies, mainstream doctors, and my Anatomy and Physiology professor, caul examination of the data shows a surprising lack of evidence to support their use. Statins decrease the risk of dying of heart disease; thats good. But they dont decrease the risk of dying overall in the majority of the population; thats bad. So then, if heart disease deaths are decreasing but overall deaths are not, statins must be increasing the risk that youll die of something other than heart disease. Im even going to go as far as to say that they cause these non-cardiovascular-related deaths. Unfortunately, most studies fail to specify exactly what these non-cardiovascular deaths are, but take a look at my previous post for an idea. If youre a woman, statins wont even reduce your risk for heart disease, and they actually increase your risk of dying overall. The only population for which statins can save lives is men with pre-existing heart disease, which is less than 5% of the population. If youre one of those people, take your statin if youre so inclined. But if youre anyone else, especially a woman, you are barking up the wrong tree.
Breastmilk is able to save the lives of premature babies
Wednesday, May 21, 2014
Breastmilk is able to save the lives of premature babies - Premature birth of a baby can be life threatening. One of them is the risk of disease in the gut area deadly. But new research from the University of Pittsburgh stated that the composition of Breastmilk a baby can save lives.
About one in every 14 babies born prematurely in the United States and Canada suffering from necrotizing entercolitis (NEC), a disease that causes intestinal tissue destroyed.
"Within 10 days after birth, the baby began to vomit, and a few hours later, the stomach so bloated and discolored," said researcher Dr. David Hackam.
Doctors did not have a choice but to lift the dead intestinal tissue. Even so, half of premature infants suffering from the condition died.
Previous research had mentioned that Breastmilk is able to reduce the risk of NEC in premature infants condition. But in many cases, Breastmilk is hard to come by, so the only formula-fed infants.
As reported by Medical Daily, Dr. Hackam and his team of researchers found that the Breastmilk components associated with the bacteria in the babys gut. Meanwhile, the baby was born without any bacteria. So as to stimulate the bacterial colonies, need Breastmilk from mother to baby.
Although the new study conducted laboratory experiments on mice, Dr. Hackam believe that premature human infants will also get similar benefits from Breastmilk. Because since the first Breastmilk is known to provide many benefits for the baby.
About one in every 14 babies born prematurely in the United States and Canada suffering from necrotizing entercolitis (NEC), a disease that causes intestinal tissue destroyed.
"Within 10 days after birth, the baby began to vomit, and a few hours later, the stomach so bloated and discolored," said researcher Dr. David Hackam.
Doctors did not have a choice but to lift the dead intestinal tissue. Even so, half of premature infants suffering from the condition died.
Previous research had mentioned that Breastmilk is able to reduce the risk of NEC in premature infants condition. But in many cases, Breastmilk is hard to come by, so the only formula-fed infants.
As reported by Medical Daily, Dr. Hackam and his team of researchers found that the Breastmilk components associated with the bacteria in the babys gut. Meanwhile, the baby was born without any bacteria. So as to stimulate the bacterial colonies, need Breastmilk from mother to baby.
Although the new study conducted laboratory experiments on mice, Dr. Hackam believe that premature human infants will also get similar benefits from Breastmilk. Because since the first Breastmilk is known to provide many benefits for the baby.
Sure Accountable Care Organizations ACOs Can Save Money But Can They MAKE Money
Tuesday, May 13, 2014
 |
| ACOs at work. |
All three institutions are using two key ingredients:
1) information technology-based risk stratification to identify the persons at greatest risk and
2) dedicated full-time nurses who perform telephonic and in-person outreach, coordinate care and provide patient coaching that, in turn, is tailored to that risk.
To the DMCB, the good news is that ACOs are using the two approaches that define modern-day disease and population health management. That industrys success will be Mt Sinais, Coastal Carolinas and Hackensacks success.
The bad news is that the news release only addresses half the question: did any savings exceed the institutions cost of the risk stratification and the nurse-FTEs? If the early answer is no, then avoided ER visits and reduced costs could turn out to be much like Governor Christies lap band: so far so good but its still risky and could ultimately be all for naught.
And on an unrelated note, this just-published New England Journal article makes note of "not made in America" health care innovations from overseas that could hold important lessons for the United States. In particular, the authors point out that Germanys DRG hospital payment system includes 30-days of post-discharge care and includes the physician payment. Readmissions within that 30 day window are, with a few exceptions, not covered and physician payment is possible because docs are often employees of the hospitals.
"Interesting!" says the DMCB, but is reminded that Germany is hardly a model for reducing inflationary cost trends. It also specifically recalls hearing Germanys Minister of Health, Daniel Bahr, express impatience with his countrys DRG system just last week. He criticized it for not advancing enough quality in his keynote address at the HauptKongress in Berlin.
Electronic Health Records Not Only Dont Save Money They Increase Health Care Costs
Friday, February 21, 2014
One outcome of the Disease Management Care Blogs authorship of this manuscript that questioned the merits of the electronic health record (EHR) was an enduring belief that these systems didnt save money. The DMCB doubted that it would increase provider efficiency, decrease avoidable complications, reduce duplicative testing or increase quality. Its best educated guess was that the impact on overall health care costs was neutral. According to six members of the United States Senate, the DMCB was wrong. They say the EHR may waste money and increase health care costs.
Thats among the conclusions of Senators Thune (R-S.D), Alexander (R-TN), Roberts (R-KAN), Burr (R-NC), Coburn (R-OK) and Enzi (R-WY) in their just-released report "Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT."
They point to the phenomenon of "code creep," which can result from using EHRs to document more extensive patient histories and physical examinations that, in turn, are used to justify an "upcoded" and theore richer bill with a higher payment. In addition, the Senators point to research that suggests code creep can be linked to an increased ordering of clinical testing and services. Last but not least, they point out that once an incorrect diagnosis enters the EHR, it is practically impossible to delete it, leading subsequent providers to mistakenly believe it is still active.
And to add insult to injury, Reboot describes the response of a "CMS official" who was asked about the above concerns. The answer was that it would take years for the Agency to better understand the phenomenon.
The DMCBs take?
Closer examination of the Senators report shows that much of the cost concerns are based on lay media reporting instead of any peer reviewed studies. That being said, there may be merit to the idea that EHRs can game billing systems. It warrants further research.
Is partisanship playing a role? The DMCB cant deny its a factor, but the same underlying motivation may be underlying CMSs unwillingness to do anything to diminish the Democrats health orm "branding."
Last but not least, the Agencys guess that it would take "years" to examine the concern is overly optimistic. There are outside analytic/research outfits that can do a faster, better and cheaper job of coming up with an answer.
The Senators and the U.S. taxpaying public deserve to know if this is true.
Can Grass Fed Beef Save the World
Wednesday, February 19, 2014
So back to the man, Allan Savory, a Zimbabwean farmer and biologist who is best known for developing the holistic management system for grazing animals. In a nutshell, holistic management aims to replicate the natural prey/predator relationship... in nature, as a defense against predators, cattle would group together in large herds, and they would keep moving, never staying in the same place for too long... it was under these conditions in which the land was kept arable, and the constant movement prevented overgrazing of any one area. Holistic management is based on replicating this natural system by rotating cattle. Joel Salatin for example, who you may know from the documentary Food Inc., uses this method to produce grass-fed beef.
Mr. Savory has used holistic management to reverse desertification in several places in Africa and around the world, making their land fertile and green again. Hes using smart, inexpensive technology to work with nature and revitalize the world. Okay Ill stop blabbering... just watch the video.
My favorite quote (19:45):
“People who understand far more about carbon than I do calculate that, for illustrative purposes, if we do what I am showing you here, we can take enough carbon out of the atmosphere and safely store it in the grassland soils for thousands of years. And if we just do that on about half of the world’s grasslands that I’ve shown you, we can take us back to pre-industrial levels, while feeding people. I can think of almost nothing that offers more hope for our planet, for your children, and their children, and all of humanity.”
Save 95 on Groceries a k a Why You Should Shop at Ethnic Markets
Wednesday, February 12, 2014
Hey folks! Were trying something new for weekends: posting an older piece from the CHG archives. This one originally appeared in October 2007. Hope you dig it.
This past weekend, I paid $0.50 for a baggie of cardamom that was selling for $10.49 the next block over. The big difference between the two stores? The $0.50 folks ran an ethnic market. The $10.49 folks ran an upscale grocery store.Six years ago, I lived in a neighborhood with two major supermarkets, both of which sold produce for above-average prices. Located 15 blocks south was a Korean-owned fruit and vegetable stand. The tomatoes, oranges, and garlic there went for half the cost of the local Key Food.
Earlier this year, a few friends needed 70 goodie bags for a promotional party. They cost about $0.34 a piece at the big-box supply store on 14th St. in Manhattan. Chinese food containers, which looked better and held more candy, went for $0.25 at Pearl River Mart in Chinatown.
It’s taken me a few years, but after Saturday’s cardamom adventure, I think I finally learned the moral of these stories: when in food-purchasing doubt, go ethnic. Whether you’re shopping for spices, produce, or supplies, those independent, family-run marts are fantastic alternatives to mega-stores. The prices are usually competitive (if not significantly lower), and the diversity of options, unbeatable. But it doesn’t end there. (Oh no – it doesn’t.) There are a bazillion other reasons why Kim’s Seafood beats out Food Lion any day of the week.
Shopping at ethic markets…
Encourages experimentation. Diversifying your diet is hard, especially when you’re locked into losing weight. If you’re looking to lift yourself from the meat-and-two-veg rut, ethnic markets are the place to be. Imagine aisle upon aisle stacked with soba noodles, yuca, and saag paneer. Even if you don’t know what any of those things are – trust me, they rule. And the store they came from can introduce your palate to all kinds of crazy flavors you didn’t even know existed.
Promotes diversity. Hey man, our families were all immigrants somewhere along the line. And according the Census Bureau, 40% of the U.S. population will be of ethnic origin by 2010. So, think of the ethnic market as a fabulous opportunity to introduce yourself to a new culture, but also, to meld that culture harmoniously into your own. While you’re perusing the shelves, take the time to speak to the proprietor or other customers. Odds are, everybody will learn something.
Reconnects you to your own culture. Are you a lapsed Swede? A part-German who’s completely ignorant of her background? A quarter-Brit with no discernible knowledge of her family’s cuisine? I am. Checking out ethnic markets gives me a good idea of what my grandparents and great-grandparents ate when they were still strolling the streets of Dublin. (Hint: potatoes.)
Helps small businesses. According to the Washington Post, family-owned ethnic grocers are losing ground as big-box supermarkets hone in on Asian, Hispanic, and African foods. Quite a few shops are even shutting their doors, and the operators’ expertise is being lost along with their leases. By buying from the ethnic market, you’re ensuring the preservation of your area, supporting a local family, and keeping that culinary knowledge alive in your community.
Ensures prepared foods are more authentic. Have you ever had sushi from CostCo? It’s excruciatingly bad. So is eggplant parmesan from Pathmark, and a burrito from Waldbaums. Oftentimes, ethnic markets will have a glass display case full of prepared foods. Try ‘em. See if you like ‘em. If you do, take some home, or try to prepare light versions on your own.
Is oh-so-hip. Eating well and frugally hasn’t always been synonymous with coolness, but it’s getting there, with lots of help from ethnic markets. According to almost every single craze-tracking source out there (magazines, websites, journals, etc.) ethnic food is consistently one of the fastest-growing trends in home cooking. (Cooking Light in particular is a big fan of meal diversification.) Buy a Ming Tsai cookbook, pick up a wok, and get with the times, man.
Makes for creative and creative gifts. Oftentimes, ethnic markets are chock-frigging-full of gorgeous tableware and cooking equipment, not to mention shelf after shelf of exotic mixes, spices, and specialty foods. And? It’s mostly pretty inexpensive. Next time you’re searching for a truly unique, out-there gift, grab a cart and go.
Can be a great bonding experience. Ethnic markets aren’t just grocery stores – they’re opportunities to spend quality time with loved ones. Teaching your kid about daikon? Learning from Grandma about what she ate in the olden days? Group-shopping for a Sunday dinner? Head for your local Indian grocer, which is a museum, a school, a library, and a food store wrapped all in one.
And last but not least (since it’s worth mentioning again), shopping at ethnic markets …
SAVES CASH. Ay-chi-wa-wa, yes. Though this might not extend to all markets/foods, you can conserve massive amounts of cash buying produce, spices, and certain ethnic specialties at the Korean place down the block, rather than the Megamart uptown. Cardamom! $0.50! Not kidding! Go!
If you’re interested in reading more about the glory of ethnic markets, these two faboo resources can help get you started:
- Wise Bread’s Tannaz Sassooni tells you what market sells which food. (Hint: Israeli = hummus!)
- After Hours’ Kathy Biehl lists a few great online ethnic markets.
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