Snow shoveling and heart attacks - Is shoveling really dangerous to the heart????

Here is Fairfield County, CT, we are still digging out from The Blizzard of 2010 just like the rest of the TriState Area and New England.

 

I spent the blizzard on-call covering our local hospital for Interventional Cardiology - that means I was the "heart attack" expert on-call.

 

Monday morning, not one but two middle aged men can in with large heart attacks that began when the went outside to try and shovel snow.

 

What makes shoveling more dangerous than other average tasks around the house is the temperature. Your heart rate and blood pressure increase during strenuous activity. That, coupled with the body's natural reflex to constrict arteries and blood vessels when exposed to the cold, is a recipe for a heart attack. Research has also shown that many people hold their breath while shoveling, which can lead to a sudden change in hear rate.

 

Snow shoveling in itself can be done safely by individuals in good shape, but can be very dangerous for those individuals who lead a most sedentary lifesytle. Unfortunately, many individuals do not have a choice - they must get out and clear the driveway. In these individuals, the body is not prepared to deal with going from 0 to 100 (the couch to the driveway) in the above mentioned conditions. This places individuals at a uniquely highrisk.

 

My recommendations:

 

Certain individuals should consult their doctor before shoveling snow:

• People who have previously had a heart attack or other cardiovascular disease.
• People with a history of chest pain or angina.
• People with medical histories of high blood pressure, diabetes or high cholesterol levels.
• People who smoke or who have other cardiovascular risk factors.
• People who do not exercise regularly.

Please be careful

Plavix and Proton Pump Inhibitors

There has been much written in the press about a potential dangerous interaction between Plavix and a commonly used class of antacids called proton pump inhibitors. This class of medications includes drugs like: omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix) ...

It is true that testing of platelets in a test tube have show that using PPI's can decrease the potency of Plavix (potentially leading to more MIs), this has not been in many observational studies. Strangely and in a surprise to most Cardiologists, the FDA forced the makers of Plavix to warn their patients about this test tube interaction.


This potential interaction has only been tested in one randomized clinical trial. The COGENT randomized almost 4,000 patients and found NO increased signal for increased cardiovascular events. What it did show was a highly statistically significant decrease in gastrointestinal events (GI bleeding and ulcers) in the patients taking both omeprazole and Plavix.

I have been using Plavix in conjunction with PPI's for years. I have never seen an increase in MI's or other cardiovascular events in these patients. The COGENT trial supports what I have seen clinically -- while there may be an interaction in the test tube, the concomitant use of Plavix and a PPI is not only safe but also possible helpful.

Our Obesity Problem

I recently read to editorials on obesity. Both of these were written as thought pieces after the announcement of first new diet pill to be approved by the FDA in over ten years. I thought both were extremely poignant and I could not have written them better myself. I agree completely with their overwhelming sentiment that overcoming our obesity epidemic needs to be a concerted effort to change our eating habits and getting moving and not with a magic diet pill.

The first piece is an editorial from the most recent Lancet

New obesity pill: new hopes, old fears

On Dec 7, 2010, the US Food and Drug Administration (FDA) Endocrinologic and Metabolic Drugs Advisory Committee gave a positive recommendation for the use of Contrave in the treatment of obesity and weight management, signalling a potentially major shift in attitude towards the disorder. Contrave, if finally approved by the FDA on Jan 31, 2011, will be the first new weight-loss drug to be approved for 10 years. The drug is a combination of bupropion, an antidepressant used to help patients to quit smoking, and naltrexone, an opioid antagonist prescribed for alcohol and drug addiction, thought to affect the reward pathway (system in which behaviour is regulated by induction of pleasure).

The use of such a drug to tackle a complex problem like obesity is worrying, especially when the benefits seem modest (a decrease in bodyweight of 5%) compared with the potential risks. Albeit no serious side-effects were recorded in the four phase-3 trials for Contrave (one of which was published in this journal), there are indices of serious risks associated with bupropion, such as suicidal thoughts, seizures, and serious cardiovascular effects. The FDA committee and the drug's manufacturer, Orexigen, agreed that a large trial to assess the risk of major cardiac events associated with Contrave was needed, but that this study could wait until after the approval.

Research into obesity has been fraught with difficulty, with many drugs having been withdrawn from the market in the past for safety reasons. The flexibility shown by the FDA in its ruling on Contrave may be motivated by a desire to encourage pharmaceutical companies to commit more funding into obesity research, as rates of obesity continue to soar. More than a third of the US population is obese, and two-thirds are either obese or overweight. But this drug showed weight loss only when combined with lifestyle modification, and should not be seen as a magic bullet. Governments should address the obesity epidemic through a comprehensive approach, focusing on the underlying causes of obesity, and not promoting medication of a disorder that should be treated with modifications of lifestyle, diet, and exercise.

The second piece I read this morning on kevinmd.com

Is it the doctor's fault if an obese patient cannot lose weight?

By John Mandrola, MD

I need help.  In dealing with obesity as a medical problem, that is.

I am pretty solid at arrhythmia management, but as an obesity doctor, not so much.  If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient's BMI.

If a student does poorly on an achievement test, is it the student's or the teacher's fault? If the obese patient does not lose weight, is it the doctor's or the patient's fault?

Recently in the NEJM, I read about Arena pharmaceutical's attempt at creating the new "wonder pill" for obesity.  Lorcaserin is a novel serotonin re-uptake inhibitor which acts primarily in the brain centers that control hunger and satiety.  Theoretically, it provides a patient with the good sense not to eat too often, and as the skinny farmer advises, leave the table before you are stuffed.

Although, Locarserin had no major adverse effects, the weight loss was modest, up to 5-10% of body weight.  Thirty pounds is only the prologue for the 300 pound patient.

So, now we may have another pill for fatness.  Like we do for tiredness, and the low sex drive of male middle-agedness.

The study conclusion is worded with scientific precision.  The researchers say, in conjunction with behavioral modification, the drug was effective in weight loss  What people hear, though, and the drug manufacturer are really saying is: take this pill and be thin.

Cynicism is knocking at my door, and I am trying to ignore it.

It is clearly true that obesity is one of the developed world's most important medical problems.  Paradoxically, while the fury of modern medicine has lowered death rates from heart disease and cancer, the obesity epidemic continues unabated.  The more sophisticated we become as a society, the fatter we get.

As a doctor of the heart, it is crystal clear that lifestyle choices lie at the heart of health. No disease is more preventable by lifestyle choices than heart disease.  And these same lifestyle choices work on obesity as well.  Call it being on "the program."  Not a diet, the program is a simple concept: finding the groove of enough exercise, wise food choices and adequate rest.

I own only one belt.  It is thick leather.  At times, as I am human, the white-chocolate-chip brownies in the doctor's lounge get the best of me.  If this behavior persists with any regularity the belt feels tighter.  Thick leather belts do not stretch. The tighter belt says, pedal a little longer and cut smaller pieces of brownie. Doing so restores equilibrium.  But if I deny too much the result is grumpiness. The pattern is repetitive.

This simple formula is the problem.

However, the notion that obesity is simply an imbalance of the equation, calories-in, calories-burned, is not in vogue.  It seems, by saying to the patient, eat less (really, it is sadly amazing how few calories a sedentary middle-aged human needs) and move more, you are at risk of being perceived as judgmental, incurious and even aloof.

If on the other hand you talk about enhanced receptor sensitivities in hunger centers that may be inhibited by sophisticated chemicals, you are smart, and a sensitive doctor.  The obese patient may conclude that poor lifestyle choices are not their fault, rather a chemical imbalance in the brain.  (And maybe this will be proven so.)

I don't think we should persecute the obese. Malfeasance is bad for the heart.  Nor am I against novel pharmaceuticals or innovative surgery.  But taking a pill or having surgery (that someone else pays for) will always be easier than saying no to white-chocolate-chip brownies.

As we advance in medical technology, the simplicity of making a series of good choices should not be overshadowed by the science of receptor inhibition in the brain.

Surely, doctors should emphasize the program more.

John Mandrola is a cardiologist who blogs at Dr John M.

Stamford Hospital featured on NBC's "Today Show" this morning

Stamford Hospital was on the Today Show this morning.

The CT woman, Charla Nash, who was severely mauled by her friend's chimpanzee made an return to Stamford Hospital.

It was a very positive story about the staff and hospital.

I'm proud to be a part of the staff at this hospital.


From the BlackBerry

Death from heart disease continues to decline but burden remains huge

Every year, I read the AHA's Heart and Stroke stats with one eye closed. I read wanting justification that my hard work is paying off. Yet, I am consistently humbled by how much work needs to be done. So, how did we do this year.

The good news: from 1997-2007
- death rates from heart disease have declined 27.8%
- death rates from stroke have declined 44.8%

Now the bad news:
- In 2007, the total cost of heart disease and stoke was $286 billion. All cancers and benign tumors only cost $228 billion
- 1/3 of Americans have high blood pressure
- > 67% of adults are overweight
- during the past 30 years, the prevalence of obesity in kids 6-11 years increased from 4 to more than 20%
- 15% of adults have total cholesterol levels of 240md/dL or greater
- 8% of adults have diabetes
- 36.8% of adults have pre-diabetes

My take: I agree with what my colleagues have been writing. We are doing really well at keeping our patients from dying. Emergency angioplasty, automated defibrillators and thrombolytic therapy has changed the acute death risk from heart attacks and strokes. Yet, the burden of disease is HUGE. I expect that at some point, we will begin the see the decline in death rates plateau as the overall burden of disease becomes overwhelming. The increasing rate of obesity in this country is scary. It will hamper our ability to continue to lower the rates of heart disease and stroke.

If the AHA is to reach is 2020 impact goal "to improve the cardiovascular health of all Americans by 20% while reducing deaths by 20% - drastic changing in the rate of obesity will need to occur. I believe this must start with our children and young adults.

We all must eat better and exercise more if we ever want to reach a time when heart disease and stroke is not the largest killer and most expensive disease of Americans.

Isn't Coumadin supposed to be dead?

Coumadin - the drug Cardiologists love to hate.

Ever since I was a medical student, I've be amazed what patients requiring Coumadin have to go through. Coumadin (warfarin) is a blood thinner, ie it keeps the blood from clotting. It is used for many conditions - atrial fibrillation, after placement of metallic heart valves, blood clots in the legs or lungs and many other conditions.

Its action is very dependent on diet, its very effected by the amount of vitamin K ingested. Therefore, patients must have frequent blood tests to ensure the level of their blood thinnest is safe (level of anti-coagulation). We use the INR to measure this. An INR of 1 is normal. For atrial fibrillation, we aim for an INR 2-3. For other conditions, we aim for an INR of 2.5-3.5. Keeping patients within this narrow therapeutic window can be difficult. Too low, patients blood and clot - in atrial fibrillation this increases the risk of a stroke. Too high, patients can spontaneously bleed. Therefore, patients need to have their blood tested at least one a month. If the levels are off and adjustments in dosage need to be made, patients may need weekly blood tests. This is a big deal for patients who need this medication indefinitely.

For years, I've been looking forward to a new medication for patient with atrial fibrillation to take Coumadin's place. I envisioned that all my patients would be immediately switched to this drug. I thought we would be able to close the Coumadin Clinic which we run in my office (15-25 patients come through this clinic on a daily basis).

Well, that time is here. But, the reality of American medicine is keeping my above dream from becoming a reality. Dabigatran (Pradaxa) has been released. It is a new class of medications called factor Xa inhibitors). Clinical trials have shown that it works better than Coumadin. It reduces strokes and other embolic and reduces significant major bleeding events. Also, its absorption is consistent and not effected by diet. Therefore, as long as it is taken morning and night, NO blood tests are required.

So, why are so few of my patients jumping on the dabagatran bandwagon? $$$$$ Coumadin, specifically generic warfarin, cost pennies. Depending on my patients insurance plan, Pradaxa costs $90-300/month.

So we have a medication that works better and is safer but is not being used because insurance companies will not pay for it.

My hope for 2011 is that more of my patients will be able to be afford this new Rx. As more and more Factor Xa inhibitors come to the market (at least 3-4 are in the works), market forces will push down the price making each Rx cheaper.

If you are interested about leaning more about this new Rx, please talk to your physician.

Exercise before eating - another way to combat holiday season weight gain

I'm not the only one writing about weight gain over this holiday season.

The New York Times is running an article today describing new research which shows that under controlled conditions exercising prior to eating leads no significant weight gain and no development on insulin resistance compared to eating prior to exercising or not exercising at all. While not eating prior to exercise will not be able to improve your performance during exercise (think competitive athletics who "carbo load" prior to a big event), it is a strategy that is helpful for those considering weight-loss).

All of this evidence is presented in the subtext of overeating around the holidays.

The article goes on to describe research from Australia where scientists have "found that after only three days, an extremely high-fat, high-calorie diet can lead to increased blood sugar and insulin resistance, potentially increasing the risk for Type 2 diabetes."

So, to avoid overeating and gaining weight this holiday season, consider my recommendations and try exercising on an empty stomach.

Fwd: Absolutely Amazing

Written yesterday --

 

Today started out in a frenzy. The entire house overslept. I'm usually up between 5:30 and 6:00am. If not, at least my wife and I can usually depend on one of our 3 children to wake us up by 6:30. Not today! Today, I awoke at 7:20!! Ahhhhh. I had to be at work (30 minutes away) to supervise a colleague performing a cardiac cath at 8am.

 

So, I'm in my car stressing out about going to work when I hear a segment on npr that totally floors me.  

This was a fascinating segment contained two stories on the treatment of  hypoplastic left heart syndrome, or HLHS for short. "In utero, the left side of the heart does not develop properly. The mitral and aortic valves, the first part of the aorta itself, and the left ventricle of the heart are small, underdeveloped or nonexistent."

 

While the first story was about the amazing success of pioneering physicians performing corrective congenital heart surgery on a newborn. The second story was the one that really got me. Now I'm a balloon guy. I spend my day in the cath lab ballooning open patients coronary arteries. Nevertheless, I was absolutely humbled by the amazing balloon work these docs in Boston were performing. They are sticking a catheter through the moms uterus, into the heart of the fetus and performing balloon valvuloplasty. Oh My Gosh! When successful, they were preventing these kids from being born with HPLH.

After listening to this segment, I totally forgot about being late to work.

Please listen - I think you too will be amazed

 

As Newborn Heart Surgery Improves, Survivors Thrive

 

Stitch In Time: Fixing A Heart Defect Before Birth

 

 

Be smart and healthy this season

I'm always amazed at how much I see people overeating during the holiday season. I read recently that the average American can gain ~ 5lbs over the holiday season. While this seams exaggerated - the New England Journal Of Medicine has reported that the average American can gain 1-2lbs over this season. The really bad news is that many Americans never lose this weight.

What to do? So many of my patients are constantly reminded of just how hard it is to lose the weight once it has been gained. Therefore, any strategy to keep the weight off in the first place seems to me to be the smartest.

Here are some ideas that I have come across to help my patients during this season of temptation.

1. Eat smaller portions of food
2. Eat slowly
3. Go for a walk after a meal
4. Off to bring a low calorie dish to the party
5. Go ahead and mingle - get away from the food
6. Say "no" to fast food
7. Be realistic - now is not the time to diet but to maintain

Whole-Grain Foods As Effective As Medication For High Blood Pressure

http://www.medicalnewstoday.com/articles/211244.php

It’s Time for Recess: Just Keep on Moving

From The New York Times

One doctor's prescription for exercise: Do it where you gather, even 10 minutes at a time.

http://nyti.ms/fMnqXb

Work Stress Raises Women’s Heart Risk

From The New York Times

In a large study, women who reported high job strain faced a 40 percent increase in cardiovascular disease and an 88 percent increase in risk for heart attacks.

http://nyti.ms/cz4DSb

Now Who Wants A Salad With That School Lunch?

Now Who Wants A Salad With That School Lunch?
by April Fulton
NPR - November 22, 2010

Salad bars in schools seem to encourage kids to eat more fresh fruits and veggies, especially if they are displayed attractively, as NPR's Allison Aubrey and others have reported.

But how to pay for it?

When the First Lady talks up school salad bars at an elementary school in Miami later today, she may face some tough questions about how much green the feds will contribute to the greens on display.

NPR's Pam Fessler puts the odds of passing the $5.4 billion child nutrition bill -- which funds school lunch and other programs -- this year at "good."

This is in part because House leaders have agreed to take up the Senate's lower-cost version.

Now that lower-cost version has some drawbacks -- like less money per lunch, and a taking of future increased dollars promised to the food stamp program, now known as SNAP benefits.

But with Republicans taking the helm in the House in January, Democrats and many anti-hunger groups are starting to realize the Senate bill may just be the best they can get, Fessler says.

Also, the Obama administration has pledged to restore the funding before the cuts take effect in 2013.

That promise has been good enough for House Democrats Jim McGovern of Massachusetts and Rosa De Lauro of Connecticut, who earlier had fought the Senate funding levels.

"We have been assured that they will work with Congress to restore this cut and use their current authorities to protect the integrity of SNAP and further improve children's access to the nutrition programs," says a Dear Colleague letter the two sent out last week with House Education and Labor Committee Chairman George Miller.

House leaders plan to take up the Senate bill on December 1st or 2nd.

UPDATE: The fruit and vegetable industry, along with a family farming group, announced today they would partner with the First Lady's Let's Move Campaign to help schools raise money to get salad bars. Read all about it here. [Copyright 2010 National Public Radio]

Another reason to stop smoking (as if you really needed one)

Heavy Smoking Linked to Alzheimer's in Study

By Steven Reinberg
HealthDay ReporterMon Oct 25, 7:08 pm ET

MONDAY, Oct. 25 (HealthDay News) -- Heavy smoking in middle age seems to increase the risk for developing Alzheimer's disease or another dementia, a large new study suggests.

"We found that people who reported heavy smoking in midlife had more than a 100 percent increase in risk of Alzheimer's disease and vascular dementia," said lead researcher Rachel A. Whitmer, a research scientist in Kaiser Permanente's Division of Research in Oakland, Calif.

"We have known that smoking is a risk factor for cancer, stroke and cardiovascular disease," she said. "This adds to the evidence that what is bad for the heart is bad for the brain."

The report is published in the Oct. 25 online edition of the Archives of Internal Medicine.

For the study, Whitmer's group collected data on 21,123 ethnically diverse people in the Kaiser Permanente health care system who were surveyed between 1978 and 1985, when they were 50 to 60 years old.

During an average follow-up of 23 years, the researchers found that 25.4 percent were diagnosed with dementia, including Alzheimer's (1,136 people) or vascular dementia (416 people), which is the second most common form of dementia after Alzheimer's disease. Vascular dementia is caused by damage to the arteries in the brain.

Compared with non-smokers, those who smoked more than two packs of cigarettes a day in midlife had a "dramatic increase" in the incidence of dementia -- more than a 157 percent increased risk of developing Alzheimer's disease and a 172 percent increased risk of developing vascular dementia, Whitmer's team found.

Former smokers and people who smoked less than half a pack a day did not appear to be at increased risk of Alzheimer's or vascular dementia, the researchers note.

The associations between smoking and dementia did not change even after adjusting for race or gender, high blood pressure, high cholesterol or heart attack, stroke or weight, they add.

A link between Alzheimer's and smoking has been shown before, but this new study pinpoints the specific risk for middle-age smokers for developing both Alzheimer's and vascular dementia, the researchers say.

Smoking, an established risk factor for stroke, may contribute to the likelihood of vascular dementia by causing small clots in the brain. Smoking also contributes to oxidative stress and inflammation, which may be linked to the risk of developing Alzheimer's disease, the researchers say.

"The brain is not immune to long-term damage from smoking," Whitmer said.

Two smaller studies of predominantly white participants also suggested that mid-life smoking raised the risk of developing Alzheimer's, researchers noted.

Commenting on the new study, William Thies, chief medical and scientific officer at the Alzheimer's Association, said "this is a sound confirmation of something that's been known for a while."

Another expert, Dr. Samuel E. Gandy, the Mount Sinai Professor of Alzheimer's Disease Research at Mount Sinai School of Medicine in New York City, said the findings are promising.

"Environmental factors in Alzheimer's disease have been long sought, and, until now, only head injury has emerged," Gandy said. "Unlike head injury, a tobacco smoking association is especially important because that is a risk that can be modified."

The "Original" Dr Portnay

I'm not the only Dr Portnay. The "original" Dr Portnay is an Internist/Endocrinologist working in the Boston area. He's one of the smartest clinicians I know. He has been my teacher for the past 39 years.

 

Here is a copy of his letter to the editor that was recently published in The Boston Globe.

 

YOUR ARTICLE "Mass. recasting health payments: Officials draft plans for new system to compensate doctors, hospitals'' (Metro, Sept. 27) is correct in that we need new ways to pay for health care. The proposed system of global payments sounds and appears attractive, but it reminds me of the managed care (HMO capitation) that we had in the 1990s.

Under that system, physicians were criticized for being so-called gatekeepers, and were blamed for limited care probably because it cost physician capitation dollars. Patients became angry at their primary care physicians for limiting access to care that patients thought they needed or wanted. This system failed miserably in spite of the cost savings.

My question to those advocating global payments for care is: How will this be different?

Dr. Gary I. Portnay

Billerica

http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2010/10/03/it_was_tried_before_called_managed_care_and_people_hated_it?mode=PF

GO DAD - I LOVE YOU. YOU'RE THE BEST!!!!

 

Another reason to observe Meatless Mondays --- $$$$$

http://www.mint.com/blog/saving/vegetarian-meals-under-10-dollars-10062010

Noisy Workplace Contributes to Heart Disease

Reed Miller

Authors and Disclosures

October 6, 2010 (Vancouver, British Columbia) — Analysis of data from the National Health and Nutrition Examination Survey (NHANES) shows that chronic exposure to occupational noise may contribute to coronary heart disease, especially among young men who smoke [1].

Some small studies suggest that noise may increase the risk of coronary disease and hypertension, but the findings have not been consistent, so Dr Wenqi Gan (University of British Columbia, Vancouver) and colleagues examined a cross-section of NHANES participants, because the survey is representative of the whole US. The results of their study are published online October 5, 2010 in Occupational and Environmental Medicine.

The study includes 6307 participants from NHANES from 1999 to 2004, age 20 and older and employed at the time of the interview. Most of the 1236 participants who reported they are chronically exposed to loud noise at work (21.2%) are male (83.3%). The average age of the noise-exposed participants is 40, and they are more likely than the nonexposed participants to be white, have a lower level of education, smoke, and be exposed to secondhand smoke. They also have a higher average body-mass index and are more likely to be regular drinkers.

Compared with participants who are never exposed to loud noise at work, those chronically exposed to occupational noise have a two- to threefold increased prevalence of angina pectoris, MI, CHD, and isolated diastolic hypertension, the study shows. After adjustment for various covariates, the odds ratios for angina pectoris, coronary disease, and isolated diastolic hypertension are 2.91, 2.04, and 2.23, respectively.

The association of noise exposure with angina pectoris, MI, and coronary disease is particularly strong for participants who are over 50 years old, male, and current smokers. However, the study did not find a significant correlation between noise exposure and increased levels of cardiovascular biomarkers, including blood lipids and circulating inflammatory mediators.

"This study suggests that excess noise exposure in the workplace is an important occupational health issue and deserves special attention," the authors conclude. They suggest that noise may contribute to the risk of myocardial ischemia or infarction because it is a "potent external stressor," like sudden emotional stress or physical exertion, and thereby activates the sympathetic nervous system and endocrine system, leading to coronary vasoconstriction and subsequent partial or complete coronary occlusion in people with or without preexisting coronary atherosclerotic plaque. The stress of noise could also lead to disruption of a vulnerable coronary plaque, the authors suggest.

The researchers acknowledge that their study did not include participants who had been exposed to workplace noise in the past but no longer work in that environment, and "the temporal relationship between noise exposure and the development of coronary heart disease is uncertain. . . . Future prospective cohort studies are necessary to clarify the relationship between previous noise exposure and the risk of CHD."

References

Heartwire © 2010 Medscape, LLC

Healing Hearts lecture series

If you are in the Stamford area tomorrow with nothing to do in the afternoon, come here me talk about "How to Outlive Heart Disease".

Stamford hospital
Tully Center
3pm

Please come and introduce yourself after the lecture, I would love to meet you.

Mouth-To-Mouth In CPR Might Be Overrated

For some time now, we have been waiting for the American Heart Association to change it's guidelines regarding CPR. 

It is clear that Hands-Only CPR is at least as effective and now maybe better than standard CPR. In fact, we've been teaching this technique in the Stamford, CT area for over a year now.  

Hopefully, we will see an official adoption of this technique in the AHA guidelines soon. 

 Mouth-To-Mouth In CPR Might Be Overrated

by Whitney Blair Wyckoff

- October 5, 2010

If the prospect of locking lips seems like an unsavory requirement for performing CPR, don't worry. A new study says you don't have to use your mouth to save a life.

A study out of Arizona found that adult cardiac arrest patients who received hands-only CPR had a higher rate of survival than patients who received conventional CPR -- which consists of both chest compressions and rescue breaths -- and those who didn't get CPR. According to the American Heart Association, 300,000 people experience out-of-hospital cardiac arrest each year in the U.S.

"Anyone who can put one hand over the other, lock their elbows and push hard and fast can save a life," said lead author Bentley J. Bobrow, a medical director for the bureau of emergency medical services and trauma system at the Arizona Department of Health Services.

The paper, which is slated to be published in the Oct. 6 issue of the Journal of the American Medical Association, evaluated the results of a public education program in Arizona that promoted compression-only CPR. The authors cite previous research showing that removing the mouth-to-mouth part of CPR makes it easier to perform.

The research looked at 4,415 adults in Arizona who went into cardiac arrest outside a hospital during a five-year period. Of those, 2,900 didn't get CPR, 666 received traditional CPR and 849 received hands-only CPR. Researchers excluded cases from the study population for several reasons, including if CPR was performed by a medical professional, if it was performed in a medical facility or there was missing data.

Those who received hands-only CPR had a 13.3 percent rate of survival to hospital discharge. Patients who didn't receive CPR had a 5.2 percent survival rate, and those who got conventional CPR were only slightly better at 7.8 percent.  Researchers also found that the rate of people providing CPR went up over the five years of the study as did the rate that the hands-only method was used.

This research follows two studies in the New England Journal of Medicine that found chest compression-only CPR is at least as effective as the traditional method.

But Bobrow told Shots that the American Heart Association guidelines make the final call on whether compression-only CPR will be universally considered on-par with conventional CPR.

Bobrow says that it's important to note that this only applies to adults -- children, he says, need the rescue breaths.  That's because in children, a respiratory emergency frequently precedes the cardiac arrest, he says.

He says that if other communities implemented a similar public health education strategy, they could save thousands a year.

"We really believe that other communities can and will implement a similar effort," Bobrow says. "Really, there is a huge potential." [Copyright 2010 National Public Radio]

Metabolic syndrome

What is the metabolic syndrome?

Metabolic syndrome affects one out of every four Americans (2/5 people over age 60).

Individuals who have at least three of the following criteria are considered to have this condition:

1. abdominal obesity
2. elevated triglyceride levels
3. low HDL cholesterol
4. high blood pressure
5. Resting blood glucose levels greater than 100 mg/dL

Those with metabolic syndrome are at increased risk for heart attack, stroke and even death.

NYTimes: Behavior: Losing Fat, as Easily as Closing Your Eyes

From The New York Times:

VITAL SIGNS: Behavior: Losing Fat, as Easily as Closing Your Eyes

A study finds sleep-deprived participants felt hungrier than others, and had higher levels of ghrelin, a hormone that drives appetite.

http://nyti.ms/c4Iize

Cheap Pill May Save Lives When Given Before Surgery

Cheap Pill May Save Lives When Given Before Surgery

by Richard Knox

- September 29, 2010

Patients at risk of a heart attack who are having surgery can cut their death risk 35 percent by simply taking a drug called a beta blocker.

The cost: A dollar per patient. That's the bottom line of a large Veterans Affairs study in the October issue of the journal Anesthesiology.

And here's why your doctor might take notice: The new study may allay earlier doubts that beta blockers for surgery patients may pose more harm than good.

The new study looked at the effect of beta blockers taken around the time of surgery in nearly 39,000 VA patients undergoing operations of any kind.

Beta blockers are widely used pills that blunt the effect of the stress hormone adrenaline on the heart, slowing the heartbeat. The idea is that in somebody at risk of a heart attack, the drug shields the heart from the stress of surgery, which can jack up the heart rate.

This isn't the first study to show a protective effect of beta blockers in surgery patients with known heart disease or cardiovascular risk factors such as high blood pressure, high cholesterol and smoking. Since 1996, a series of studies that randomly assigned such patients to beta blockers or placebo pills suggested the drug could lower death risk by up to 90 percent.

The new study is not a randomized trial. It looked back at how many people died within a year of surgery if they took beta blockers or not. Its authors say this provides a more realistic picture than carefully controlled look-ahead studies.

"This is what happens in real life," says study leader Arthur Wallace of the San Francisco Veterans Affairs Medical Center. "And still it reduces mortality by 35 percent. That's pretty good."

Wallace says about half of hospitals have adopted the routine use of beta blockers in at-risk surgery patients. If it were universally used, he says, it would save about 7,000 lives a year.

He hopes the new study will address doubts raised by a 2007 study called the Perioperative Ischemic Evaluation trial, or POISE. It concluded that beta blockers prevent heart attacks among surgical patients, but raised the risk of deaths and severe strokes.

In the wake of POISE, an expert committee of the American College of Cardiology and the American Heart Association last year backed away  from its earlier recommendation to use beta blockers routinely in surgical patients with known or suspected heart disease. The new guidelines urge more care in the timing and dose of beta blockers for surgery patients.

"When POISE came out, we thought, oh my goodness, maybe we've done something wrong," Wallace says. "We've been telling people for 10 years to use this drug. Maybe we've made a mistake."

So the San Francisco group decided to use the VA's computerized record system to see how beta blockers affected the death rate among its surgical patients from 1996 to 2008.

The new study found no evidence that patients who got beta blockers around the time of surgery had more strokes. "We just didn't see any strokes," Wallace says. "We didn't have enough to say anything about it."

He says the POISE study came up with different results because it used an unusually high dose of beta blockers – 16 to 32 times higher than the usual dose.

One other apparent lesson from the new San Francisco study: It's a very bad idea to take beta blockers away from patients already on the drug when they enter the hospital for surgery. The VA study finds that quadruples patients' risk of death.

Wallace says hospitals routinely stop patients' routine medications when they come into the hospital to prevent bad drug interactions. "We have to change the way pharmacies think," he says. [Copyright 2010 National Public Radio]

High-Tech Runners Train Smarter With GPS

High-Tech Runners Train Smarter With GPS
by Tamara Keith

- September 25, 2010

It used to be all runners needed were a good pair of shoes and an open stretch of trail. But even this most basic sport has gone high-tech.

Many runners swear by their GPS watches that constantly update pace and distance. Now, smart phones with built-in GPS offer new tools to even more runners in the form of running applications.

I'm a runner. Not a good one, not a fast one, just a runner. I'm also a total gear head.

I'm the person you see coming down the trail with a GPS wristwatch on one arm, an MP3 player on the other, water bottles strapped to my waist and compression socks pulled up to my knees.

I realize this is super geeky, but I love to know precisely how fast I'm going. If my GPS says I've gone only 5.95 miles, I'll run up and down my driveway to get it up to 6.

So of course one of the first things I did when I got my new iPhone was install a bunch of running-related apps: RunKeeper, iMapMyRun, the Nike+ GPS app and one from adidas called miCoach.

With miCoach, you set up a training plan online, and then the app guides you through your runs with voice cues. I take it out for a run around the National Mall and as I go, the app's friendly female voice tells me I need to speed up.

"Speed up to yellow zone. Five minutes," the voice says.

I'm breathing heavy, and running fast -- or at least, I think I am -- when the app says again, "Speed up to yellow zone."

And so I do speed up. When the run is complete, the app offers a little encouragement.

"Great job," the voice says mechanically. "Time: 35 minutes. Calories: 365."

Like all of these running apps, miCoach allows you to check your stats, see the run on a map, tweet your results, and upload data to the Web. They cost less than $10 each and have slightly different bells and whistles.

"I've actually gotten quite addicted to the data and the specific information that I can get in real time and then sort of play with after my run," says David Willey, editor-in-chief of Runner's World magazine.

A regular user of iMapMyRun and RunKeeper, Riley says in the past only very serious or elite professional runners got this kind of coaching and detailed information. Now, anyone can.

"There are probably more runners that are out there training smarter than there ever have been, because of this technology and the sort of democratization of technology," Willey says.

And then there are people like my running partner Rich Cohen, who has been a runner since college and can easily finish a 6-minute mile.

"It's nice to just go out there with your watch and just enjoy the outdoors, and enjoy the nice weather and people running around you and maybe some of the scenes," Cohen says.

When he says "watch," he's not talking about one with a built in GPS -- just a plain old watch so he knows what time it is. Rich and I run together when he wants to take it slow. And I get the sense that he thinks all my gear and technology are silly.

"If I want to run 6 miles, I'll go for about 45 minutes. If I feel like I'm going a little slower, I might add on a few minutes," Cohen says, "So I don't feel a need to say I'm going out at 7:30 a mile. I need to run 7:30 a mile for 6 miles to feel like I accomplished what I was trying to do that day."

But if you do want to know exactly how far and exactly how fast you went, there are now plenty of options. [Copyright 2010 National Public Radio]

Vein Study Gets a Rare Challenge

From The New York Times:

Vein Study Gets a Rare Challenge

An editorial in The New England Journal of Medicine took the unusual step of criticizing a study on a blood-thinning drug published in the same edition.

http://nyti.ms/cEMQeB

World Heart Day 2010

HeartPatients Foundation Support Group for People suffering from Heart Diseases Worldwide A message to all members of HeartPatients Foundation World Heart Day was created to inform people around the globe that heart disease and stroke are the world's leading cause of death, claiming 17.1 million lives each year. Together with its members, the World Heart Federation spreads the news that at least 80% of premature deaths from heart disease and stroke could be avoided if the main risk factors, tobacco, unhealthy diet and physical inactivity, are controlled. World Heart Day will be held on Sunday, 26 September 2010 * On 26 September 2010 – 10 years after the first World Heart Day in September 2000 – the World Heart Federation and its members are celebrating progress in heart health. * At this 10-year milestone, the World Heart Federation is urging governments, healthcare professionals, employers and individuals to reduce the burden of heart disease and stroke. * Building on last year and to ensure sustained change, the World Heart Federation is targeting the workplace to promote heart healthy messages. The Workplace Wellness initiative aims to use the workplace to promote long-term behavioural changes that will benefit employers, employees and communities. On World Heart Day, we call on everyone to take responsibility for their own heart health and say "I work with Heart". By outlining 10 simple steps that can be taken and encouraging people to start by taking at least one; healthy diets, physical activity and saying no to tobacco is advocated. 10 simple steps 1. Healthy food intake - Eat at least 5 servings of fruit and vegetables a day and avoid saturated fat. Beware of processed foods, which often contain high levels of salt. 2. Get active & take heart - Even 30 minutes of activity can help to prevent heart attacks and strokes and your work will benefit too. 3. Say no to tobacco - Your risk of coronary heart disease will be halved within a year and will return to a normal level over time. 4. Maintain a healthy weight - Reducing weight, especially together with lower ed salt intake, leads to lower blood pressure. High blood pressure is the number one risk factor for stroke and a major factor for approximately half of all heart disease and stroke. 5. Know your numbers - Visit a healthcare professional who can measure your blood pressure, cholesterol and glucose levels, together with waist-to-hip ratio and body mass index (bmi). Once you know your overall risk,you can develop a specific plan of action to improve your heart health. 6. Limit your alcohol intake - Restrict the amount of alcoholic drinks that you consume. Excessive alcohol intake can cause your blood pressure to rise and your weight to increase. 7. Insist on a smoke-free environment Demand a tobacco ban - ensure your workplace is 100% smoke-free Support the adoption of smoking - cessation services encourage your employer to provide help to those wanting to quit tobacco 8. Bring exercise to the workplace - Include physical activity in your working schedule - cycle to work if this is possible, take the stairs, exercise or go for a walk during your lunch breaks, and encourage others to do so too 9. Choose healthy food options- Ask for healthy food at your work canteen, or find nearby cafes or restaurants that serve healthy meals 10. Encourage stress-free moments -whilst stress has not been shown to be a direct risk fact or for heart disease and stroke, it is related to smoking, excessive drinking and unhealthy eating, which are risk factors for heart disease. - Take time for lunch away from your workplace to get some fresh air - Have regular breaks during the day - try stretching or exercising for 5 minutes twice a day What activities are you planning in your city? Join the discussion at http://www.heartpatients.com/forum/topics/world-heart-day-2010 regards, Heart Patients Foundation www.HeartPatients.com

NYTimes: Web Tool to Check Heart Risk Is Doubted

From The New York Times:

Web Tool to Check Heart Risk Is Doubted

Critics of a calculator intended for pencil-and-paper users raise questions about the drug industry's motives in promoting a gauge that shifts more people into higher-risk groups.

http://nyti.ms/9FgGtx

Calif. Whooping Cough Cases Near 55-Year High

http://www.npr.org/blogs/health/2010/09/17/129929225/calif-whooping-cough-cases-near-55-year-high?sc=ipad&f=1128

Calif. Whooping Cough Cases Near 55-Year High
by Scott Hensley

NPR - September 17, 2010

The sad story of the whooping cough epidemic that's hit California this year keeps getting sadder.

The state health department now says there have been nine death -- all babies. All the infants were 2 months old or younger when they got sick. Eight were Hispanic.

Overall, more than 4,000 cases of whooping cough, or pertussis, have been reported this year. That's the most since nearly 5,000 cases were reported in 1955, and the year is far from over.

Among the cases that public health authorities know have led to hospitalization, nearly three-quarters involved children less than 6 months old. Of those kids, 77 percent were Hispanic. For a full statistical report, see the data released this week by the California Department of Public Health.

Kids can get their first shot against whooping cough at 2 months.  But three shots, usually done by 6 months, are needed to be sure a child's immune system can fight off the bacteria that cause pertussis.

To protect the youngest and most vulnerable children, it's important that relatives and the community at large be vaccinated to prevent spread of the whooping cough.

Data just published by the Centers for Disease Control and Prevention show that in 2009 about 95 percent of American kids, aged 19-35 months, had three or more doses of the vaccine combination that protects against pertussis. But in California, a measure of the uptake of a series of recommended vaccines found only about 72 percent of the kids that age had the shots they needed.

Earlier this month, Canada advised travelers to California make sure their whooping cough vaccinations are up to date before making the trip. [Copyright 2010 National Public Radio]

To learn more about the NPR iPad app, go to http://ipad.npr.org/recommendnprforipad

NYTimes: Teaching Doctors About Nutrition and Diet

From The New York Times:

DOCTOR AND PATIENT: Teaching Doctors About Nutrition and Diet

Physicians still don't know enough about food and diet, and some medical schools are seeking to change that.

http://nyti.ms/bsTrIJ

Yale Cardiologist Taps Data To Shape Health Decisions

I had the absolute honor of spending a year working with Dr Krumholz. I am a better doctor and person because of that year. 

Yale Cardiologist Taps Data To Shape Health Decisions
by Scott Hensley

NPR - September 10, 2010

If you want a face to put on the movement to base medical decisions on hard data, you could do worse than Dr. Harlan Krumholz.

A Forbes profile by Matt Herper calls Krumholz, a 52-year-old cardiologist at Yale, the "most powerful doctor you never heard of."

What's the big deal? Well, for going on 20 years Krumholz has been asking big questions about what works best, and then why doctors aren't making sure it's done.

"Every day millions of patients are being treated, and the lessons from their experiences are lost because there is no systematic effort to learn from them,"  Krumholz tells Forbes. "If I'm sitting down with a patient, I should be able to take advantage of everything we have learned up until yesterday to treat them."

He's looked at the rates of heart attack patients getting aspirin, time from hospital admission to angioplasty, and lately hospital readmissions for heart failure patients.

A few months back Krumholz brought his message to the masses, or at least to a bunch of folks inside the Washington Beltway, with an op-ed on the value of finding treatments that don't work. "Rather than a letdown, the failure to find an advantage in an expensive strategy opens the door to doing less and spending less without worsening patient care — and in some cases improving it," he wrote in the Washington Post.

Here's a video that features Krumholz (after Cleveland Clinic cardiologist Steve Nissen) talking about the symptoms of heart attack: [Copyright 2010 National Public Radio]

To learn more about the NPR iPad app, go to http://ipad.npr.org/recommendnprforipad

Why Do Doctors Take Drugmakers' Gifts?

Why Do Doctors Take Drugmakers' Gifts?

by Scott Hensley
NPR - September 15, 2010

Ever since drugmakers first started selling prescription medicines, they've been currying favor with doctors who write the orders.

So why do so many physicians, who, even now, earn more money and maintain more public trust than most of us so readily accept the drug industry's blandishments?

Well, a clever study that surveyed hundreds of young pediatricians and family practice doctors found, basically, the doctors think they're worth it.

The likelihood that doctors will look kindly on gifts rises as they're reminded of their long hours and educational debts. Then offer doctors this rationalization:

Some physicians believe that the stagnant salaries and rising debt levels prevalent in the medical profession justifies accepting gifts and other forms of compensation and incentives from the pharmaceutical industry. To what extent do you agree or disagree that this is a good justification?

Even if they say they disagree with the proposition, just showing it to them increases the odds they'll say gifts are OK.

Overall, the researchers from Carnegie Mellon found that reminding doctors of the sacrifices they've made improves their view of gifts.

Only about 22 percent of doctors asked about gifts in the context of conflicts of interest said they're fine. For those who were reminded of sacrifices, the percentage who found gifts acceptable jumped to about 48 percent.

Then throw in the rationalization about debts and stagnant pay, and the percentage who would be OK with an industry-sponsored gift rose to 60 percent.

The results appear in the latest issue of JAMA. [Copyright 2010 National Public Radio]

BENEFITS OF EXERCISE

We all know exercise can help you stay trim and in shape, but there are a number of health benefits sometimes overlooked:

• Helps prevent chronic diseases (such as hear t disease), stroke, and diabetes
• Improves your overall mood
• Reduces high blood pressure
• Reduces stress
• Strengthens muscles, bones, and joints
• Improves metabolism and increases your energy level
• Strengthens immune system
• Helps prevent depression
• Increases bone density, which helps prevent osteoporosis

NYTimes: Companies Race to Develop Drugs to Reduce Blood-Clotting Problems

From The New York Times:

By NATASHA SINGER

The drugs are aimed at people who have a higher than normal risk for clotting or stroke, like patients undergoing hip replacement surgery or those with an irregular heartbeat. ...

http://www.nytimes.com/2010/08/31/health/research/31drug.html

If in the neighborhood -- COME JOIN ME

What you eat when you're young can make a big difference in how healthy your heart is later.

Published: August 03, 2010

by Patti Neighmond

Researchers say too much cholesterol isn't safe -- at any age.

And a recent study suggests it really does matter what you eat and how much you exercise in your 20s and 30s.

How come? A heart-healthy diet and regular exercise can lower LDL, or "bad" cholesterol. That's the stuff that can really clog up arteries that feed the heart.  And, it turns out, the clogging process starts early.

So it's never too soon to start being nicer to your heart. Seems obvious, right? But researchers say the medical community hasn't fully appreciated the consequences of high cholesterol during young adulthood.

Now, though, a study in the Annals of Internal Medicine sheds some interesting light on how plaques build up.

Researchers found individuals who had moderate or high levels of bad cholesterol or lower levels of HDL, the good cholesterol, as young adults were more likely to develop spots of calcium in plaques of their coronary arteries. Those calcium deposits can be seen by a CT scanner and are a marker for heart disease.

Bottom line: 44 percent of people with abnormal cholesterol in their 20s developed coronary calcium by their mid-40s, compared with only 8 percent of those with normal cholesterol levels.

The study began in 1985 and involved healthy, young men and women in their 20s. Researchers followed the nearly 3,300 people for two decades.  Researchers measured cholesterol levels and triglycerides (blood fat) over the 20 years.

The work was funded by the National Heart, Lung and Blood Institute. [Copyright 2010 National Public Radio]

For Longer Life, Keep Your Waist Trim

Published: August 09, 2010

by Chao Deng

If you want an idea of how long you'll live, take a good hard look at your waistline the next time you're in front of a mirror.

Researchers from the American Cancer Society say people with large waists have twice the risk of death compared to those with small waists. The researchers defined large waists as more than 47 inches for men and greater than 42 inches for the ladies.

The results held up even for those who had a normal weight for their height. The findings were just published online by the Archives of Internal Medicine.

What's going on? Extra inches at the waist mean more fat tissue deep in the abdomen, explains lead author Eric J. Jacobs.

Previous research has shown that fat in the abdomen doubled a person's risk of death from many causes, including cancer, stroke and heart disease. A big waistline is a better indicator of health risks than body mass index (BMI), the usual measure for obesity, according to some research.

The recent study followed thousands of men and women for nine years, but had a few shortcomings. All of the people were 50 or older, and nearly all were white.

Jacobs says there's no reason to expect radically different results in other ethnicities and that researchers have shown similar results in younger people. His advice: "Watch your waist as well as your weight." [Copyright 2010 National Public Radio]

What Contributes to High Blood Pressure

Several factors may contribute to high blood pressure (and cardiovascular disease):

- excess dietary salt
- excess alcohol intake
- stress
- age
- genetics and family history
- obesity
- physical inactivity
- high saturated fat diet

Calcium Supplements May Increase Heart Risk

Calcium Supplements May Increase Heart Risk
by April Fulton
NPR - July 30, 2010

Before you pop that calcium supplement, you might want to talk to your doctor.

A new analysis out in the British Medical Journal says calcium supplements may increase the risk of heart attack by 30 percent.

Calcium supplements have become practically de rigueur components of the pill boxes of 50-something women. They've been touted as a simple way to improve bone density and help guard against fractures for both genders.

The researchers suggest that while the increased risk is small, the widespread use of calcium supplements makes it a pretty big deal.

"Even a small increase in incidence of cardiovascular disease could translate into a large burden of disease in the population," the researchers conclude.

"The risks outweigh the benefits," Professor Ian Reid at the University of Auckland, who headed up the analysis team, told NutraIngredients.com.

Another researcher, Alison Avenell, told the BBC that taking the supplements is a matter of "balancing risks."

The analysis also suggested the supplements might slightly increase hip fractures and have only a modest overall effect on reducing all kinds of fractures.

But cardiologist John Cleland of the Hull York Medical School in England told WebMD that the analysis is "concerning but not convincing."

He said he was surprised that there was no increase in deaths, only heart attacks.

The analysis looked at data from 11,000 people pooled across 12 different calcium clinical trials from the last 20 years. They were aged 40 and up.

It specifically excluded patients given calcium supplements plus Vitamin D supplements. Vitamin D deficiency has been linked to increased risk of heart problems, and is being studied separately.

And, it did not find an increase in heart attacks among those who boosted their calcium the old-fashioned way, through food.

Reid suggests that this could be related to higher blood calcium levels found in supplements, which can lead to hardening of the arteries, which can then cause heart attacks.

"Food remains the best source of calcium. Calcium supplements should only be used when adequate dietary intake cannot be achieved," a spokeswoman for the National Osteoporosis Foundation told Shots.

The U.S. Recommended Daily Allowance for calcium for adult men and women is 800 to 1200 mg per day. For those under 50, it's up to 1,000 mg.

That's a lot of milk, salmon, cheese and sardines.

CORRECTION: An earlier version of this post grouped prescription Fosamax, Boniva and Actonel in with calcium supplements. These products are not calcium supplements, although they are often prescribed along with calcium supplements to help prevent osteoporosis. [Copyright 2010 National Public Radio]

Cholesterol Screening Rates Too Low in Young U.S. Adults

Jul. 19, 2010 10:00 AM

HealthDay

MONDAY, July 19 (HealthDay News) -- Only about half of young adults in the United States undergo cholesterol screening, even though up to one-quarter of them have elevated levels of "bad" cholesterol, a new study has found.

U.S. Centers for Disease Control and Prevention researchers analyzed data from nearly 2,600 young adults (men aged 20 to 35, women aged 20 to 45) who took part in the U.S. National Health and Nutrition Examination Survey.

Elevated levels of low-density lipoprotein (LDL, or "bad") cholesterol were present in 7 percent of the participants with no other heart disease risk factors, 12 percent of those with one other risk factor, and 26 percent of those with two or more other risk factors, the researchers found. However, the cholesterol screening rate for young adults is under 50 percent, they noted.

A high level of LDL cholesterol is a common risk factor for coronary heart disease, but it can be managed with lifestyle changes or treated with medication. Other risk factors include high blood pressure, smoking, family history and obesity, the study authors noted.

"What's surprising and, quite frankly, rather concerning, is that we are doing such a poor job of identifying young adults in America who have elevated LDL cholesterol," study lead author Dr. Elena Kuklina, a nutritional epidemiologist with the CDC Division for Heart Disease and Stroke Prevention, said in an agency news release.

"Young men and women experience a high burden of risk factors for heart disease, the nation's leading cause of mortality," she added.

The study findings, published in the July/August issue of the journal Annals of Family Medicine, highlight the need to improve screening for, and management of, high LDL cholesterol among young adults, according to the researchers.

How the Massachusetts gift ban hurts primary care doctors

Great opinion piece on "gift bans". In the end, these bans will be just as hurtful as they are helpful.

http://goo.gl/fb/VvwgV


From the BlackBerry

FDA Approves Generic Blood-Thinner, Opening Door For More Biotech Copycats

FDA Approves Generic Blood-Thinner, Opening Door For More Biotech Copycats

by Scott Hensley
NPR - July 23, 2010

Enoxaparin is a mouthful. But if you're at risk for developing blood clots, you might practice saying it.

The soothing female voice at Davis's Drug Guide says e-nox-a-PA-rin (click on link to listen). So why might you care?

Well, the Food and Drug Administration just gave a thumbs-up to a generic version of enoxaparin, an anticoagulant, that will be sold by a unit of the Swiss drug giant Novartis.

That's a big deal because for years the drug -- nearly a $3 billion-a-year seller in the U.S. -- has been available under the brand-name Lovenox from Sanofi-Aventis. The FDA also says pharmacists can substitute the generic drug for the brand. And it should be cheaper, too.

On all those counts, the generic approval is important. But even more significant, the FDA's approval of generic Lovenox, which is a complicated mixture of long chains of sugars, shows the agency can move ahead on generic versions of biotech-style drugs.

The drugmaker now known as Sanofi-Aventis fought against the approval all the way. But the agency didn't buy the company's arguments, which are refuted here.

As Forbes Robert Langreth explains, the FDA requirements for generic Lovenox are "a test case" for how the agency could handle "copycat versions of complex biological drugs." [Copyright 2010 National Public Radio]

Florida Hospitals Seek To Reduce Post-Operative Infections, Complications

This sounds like a terrific idea - we should be doing something like this in CT

The Orlando Sentinel (7/18, Shrieves) reported that 81 "hospitals in
Florida are teaming up with one important goal: to reduce the number
of infections and complications that occur after surgery." For
hospitals, "fewer complications could reduce the sorts of costs that
will come under increasing scrutiny with the new federal
health-overhaul law." The paper says "currently about one in five
patients" discharged from the hospital is readmitted for
complications, costing an additional "$11,000 or more." Starting this
fall, hospitals will study four types of hospital patients such as
those who developed urinary-tract infections, and find out which
hospitals have low rates of surgical complications, so others can
learn from them.