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]

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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]

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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