Fastrack Archive July 2011

Friday       July 1, 2011

Adverse Medical Events Outside the Hospital

Most clinical trials assessing adverse medical events (AMEs) have focused on inpatient care. Now there is a study looking at AMEs in private practice and it shows that the numbers are about the same.  Most AMEs are from surgeries, diagnostic testing, and treatment errors.  Every year there are about 11,000 paid malpractice suits that represent the tip of the iceberg and this comes to more than 2 billion dollars a year. The practice of medcine is extremely difficult and AMEs should be expected. Our MDs are rushed, given research articles that are misleading, and challeged by an epidemic of illness that is very complex and difficult to treat. 

We need to shift today's medical paradigm from disease management to wellness and prevention. This would not only save enormous expenditures, but provide better care that is more effective.

Monday      July 4, 2011

Fat Substitutes Don't Work

Fat substitutes such as Olestra result in weight gain, not loss! They disrupt the body's mechanisms to control food intake. Olestra works by binding up to 8 triglyceride molecules in such a way that the enzyme lipase cannot begin the fat digestive process and it passes out with the stool. Side effects include abdominal cramping, diarrhea, and oily stools. Its best use is as an industrial lubricant, paint additive, deck stain additive, and as a detoxicant for dioxin and PCB poisoning. It is banned in the UK and Canada.

Tuesday       July 5, 2011

High Dose Statins Associated with Increased Risk of Diabetes

A meta-analysis showed that high dose statin therapy as primary prevention caused an increased risk for type 2 diabetes. The article published in JAMA goes on to say that treatment of 32,000 non-diabetics with 5 years high dose statin treatment caused 149 more cases of type 2 diabetes, but 416 fewer cardiovascular events.

This is a very misleading journal article that JAMA should be ashamed of itself for publishing. It gives the idea that primary prevention with high dose statins is a good idea. Hogwash! They fail to mention that 80 people need to be treated for 5 years with this regimen to prevent one MI and save no lives. They also fail to mention that there are many other side effects of statins that need to be calculated into the equation before leaving the reader with the thought that high dose statins are a good idea for everyone!

Wednesday    July 6, 2011

Inhaled Steroids Cause Fractures

Patients with COPD who use inhaled corticosteroids to imporve breathing for more than six months have a 20% increased risk of bone fractures.   The risk goes up as the dosage increases.  It was previously assumed that inhaled steroids would have a predominantly local effect, but now we know this is not true.  Treatment should consist of lowering or discontinuing inhaled steroids and supporting bone growth with weight bearing exercise and nutritionally with Vitamins D and K, calcium with micronutrients, and strontium.

Thursday      July 7, 2011

Preventive Benefits of Medicare

The Centers for Medicare and Medicaid Services (CMS) reports that 5 million Americans took advantage of one or more of the recommended preventive benefits available through the affordable care act. Among the benefits is the new annual Wellness Benefit Visit.  The idea is to either to detect early or prevent chronic diseases with tests such as mammograms, bone density tests, colonoscopies, diabetes screens, immunizations, and screening for prostate cancer so we can enjoy better care and better health at lower costs through improved health care.

Seventy percent of Medicare beneficiaries have at least one chronic disease and 38% have between two and four. They see an average of thirteen different doctors and fill an average of 50 prescriptions or prescription refills per year!  It is estimated that the US could save about 2/3 of the 2.5 trillion dollar medical budget.

Friday       July 8, 2011

Silicone Breast Implants are Temporary

Women who get silicone breast implants are likely to need additional surgery within 8-10 years to address complications such as rupture of the implant. There are 400,000 breast implant and reconstructive procedures annually in the US. The most common complications include rupture, wrinkling, asymmetry, scarring, pain, hardening of the breast around the implant and occasional cancer.

There are many purported associated diseases such as Sjogren's disease, lupus, scleroderma, ALS, and MS that are implicated as as caused by implants, but evidence is essentially lacking.

There are many reasons for considering an implant such as reconstruction because of breast cancer, very small breasts, and asymmetrical breasts. We need to meet people where they are and not be judgmental until we've walked in their shoes!

Monday    July 11, 2011

When is it Important to Take Your Medicine

The AMA reports that noncompliance with regard to prescription medication is the cause of excessive hospitalization, morbidity, mortality, and overall healthcare costs. The article fails to address those patients who suffer from adverse drug events and their related costs. They state that health costs go up about $300 billion annually because of drug noncompliance, but fail to acknowledge that there is also about the same amount of money spent dealing with adverse drug events!

Sadly, there is no good data comparing the benefits and adverse outcomes from using pharmaceutical drugs across the board. We have simply assumed that the benefits outweigh the problems related to drug treatments. There is no doubt that for certain situations there are tremendous benefits from pharmaceutical drugs. There is also no doubt that for other situations there is more harm than good. We need to take a careful look at this problem through clinical trials.

Tuesday       July 12, 2011

Medical Residency Training Reform

Medical experts are calling for resident working hour restrictions to prevent medical errors from medical resident fatigue and lack of supervision. They called for sweeping changes in the design, supervision and financing of US hospital residency programs to protect both patients and medical residents in training from serious, preventable medical errors, and end dangerously long work hours.

There is no justification for maintaining unsafe work hours, other than they save hospitals substantial sums of money that would need to then be spent to pay for more physicians or physician assistants. This could come to tens of millions of dollars every year that they don't want to pay.

Wednesday      July 13, 2011

Ethical Issues in Medical Research

Yale School of Medicine researchers found a clinical trial with neurontin was a seeding trial used by Big Pharma to promote the drug and increase prescriptions. Seeding trials are not illegal but are unethical because they offer no research. They took advantage of 2700 patients and 772 investigators to complete the publication. These people gained nothing for their participation.

In another study, surgeons in Medtronic trials failed to report serious complications that included 10-50% of patients who developed problems including cancer, sterility, infections, bone dissolutions and worsened back and leg pain. Fifteen surgeons collected $62 million from the company for their work!

Lastly, Joseph Biederman, MD from Harvard accepted more than a million dollars from Big pharma to further his work suggesting that most ADHD and ADD patients were actually bipolar and needed the medications sold by the companies supporting his work. What some people will do for money and fame is shocking.

Thursday     July 14, 2011

How to Assess Your Blood Pressure

The best way to assess your blood pressure is to take multiple home readings. This is more accurate than taking blood pressures in the doctor's office because of the "white coat syndrome." Many people are treated for high blood pressure and don't have it a all! Overtreatment leads to complications from medications as well as hypotension (low BP). It is also a good idea to titrate BP medicines to home values on a daily basis.

We also know that if there is more than a 10 mm of Hg difference in BP between the left and right arm, the risk for a complication of high BP goes up dramatically. BPs should be measured at least one time in both arms simultaneously.

Friday    July 15, 2011

Common Drugs Linked to Cognitive Decline

Medications with anticholinergic activity, which include many drugs taken by older adults, cause cognitive impairment. Over the counter sleeping aids such as Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom are especially problematic. Other drugs include Paxil, Detol, Demerol, and Elavil. Anticholinergics work by blocking the brain's neurotransmitter, acetylcholine.

In a study published in the June 24, 2011 issue of the Journal of the American Geriatrics Society, researchers studied the impact of these medications on 13,000 people over the age of 65 by measursing tests in cognitive function of those taking anticholinergic drugs and those not. The results were striking.

Far too many doctors recommend these drugs and don't realize their impact.

Monday      July 18, 2011

Can Aredia Kill the Influenza Virus?

An old osteoporosis drug, Aredia, may be effective in killing a range of influenza viruses that include the swine and bird flu. In the June 2011 issue of the Journal of Experimental Medicine, researchers showed that Aredia stimulated gamma-delta T-cells to reproduce and also kill influenza viruses. Rather than killling the virus directly, it does so through the body's ability to produce cells that kill the virus. This might protect against the novel ability of the flu viruses to mutate as a defense against antibodies that are specific to their DNA structure. Experiments with mice showed that Aredia was a very powerful protective strategy against the swine flu and two different bird flu viruses. It also works quite differently than drugs such as Tamiflu, that work directly against the virus.

Tuesday        July 19, 2011

H. Pylori: Good or Bad?

Infection with H pylori provides reliable protection against allergy-induced asthma by impairing the production of dendritic cells and triggering the accumulation of regulatory T-cells. Researchers published in the Journal of Clinical Investigation that the dramatic increase in allergic diseases in industrialized countries is linked to the rapid disappearance of specific micro-organisms that populate the human intestinal tract.

Other factors predisposing to the development of asthma include air pollution, smoking, and the hygiene hypothesis, and the widespread use of antibiotics.

Wednesday      July 20, 2011

Copper Kills 97% of ICU Bacteria

Antimicrobial copper surfaces in ICU kill 97% of bacteria that can cause hospital-acquired infections (HAI). This translates into a 40% reduction in the risk of getting an HAI. Five percent of all hospitalizations are complicated by an HAI and this leads to more than 100,000 deaths annually in the US. Copper should be put on bed rails, tray tables, call buttons, IV poles, faucet handles, toilet seats, door plates, light switches, grab rails and much more. It kills MRSA, C. diff, lysteria, influenza and many other microbes. Copper also has anti-inflammatory effects and copper bracelets have been reported to cure inflammed tissues.

Thursday        July 21, 2011

Do We Do Too Many Angioplasties and Stents?

Most angioplasties and stents used to treat acute heart attacks or unstable angina in the US are necessary and lifesaving. We know that these procedures are not indicated for people with coronary artery blockages who are stable; only about 3% benefit from these invasive procedures compared to medical treatment alone using pharmaceutical drugs. There is also a place for supporting people with coronary artery disease with lifestyle measures and natural treatments using supplements such as coenzyme Q10, l-carnitine, fish oil, taurine, nattokinase, and much more.

Friday         July  22, 2011

Does Salt Cause Heart Attacks?

Researchers published in the Cochrane Library that there is no evidence that moderate cuts in salt intake reduce the risk of a heart attack or dying prematurely. Salt does lower blood pressure mildly. Yet salt is essential for survival. The difference between table, sea, and Himalayian salt are reviewed. The effect of salt intake in congestive heart failure and on edema is discussed.

Monday        July 25, 2011

NSAIDs Linked to Atrial Fibrillation

NSAIDs have now been linked to an increased incidence of atrial fibrillation and flutter. The association was strongest for new users. The risk is increased by 40% for COX-1 inhibitors and 70% for COX-2 inhibitors such as Celebrex. This translates to 1 in 250 taking COX-1 drugs and 1 in 140 taking Celebrex. The risk is highest for the elderly, those with rheumatoid arthritis and chronic kidney disease. Other side effects of this class of drugs include heart attacks, strokes, ulcers, and kidney failure.

Tuesday         July 26, 2011

Fewer Mammograms Needed for Low-Risk Women

Less frequent mammograms for wonem at low risk for breast cancer can be a cost effective way of saving lives. Women with no family history of breast cancer, no previous biopsy and breasts that are not dense need far fewer mammograms than women with these risk factors. For women under the age of 50 without these three risk factors, mammograms are not worthwhile. To save one life among women under the age of 50, 8000 women would have to be screened and 17% would experience a false positive cancer scare that would lead to more radiation and a biopsy. Women with dense breasts under age 50 would benefit from a mammogram every three to four years. For older women without these three risk factors, it is cost effective to do mammograms every 3-4 years. For those with denser breasts, every two years is recommended.

Wednesday       July 27, 2011

Low Dose Naltrexone

Low dose naltrexone (LDN) has been implicated to help with cancer, HIV/AIDS, autoimmune diseases, and much more. Now it has been shown to have a potent antitumor effect on  human ovarian cancer in both tissue culture and in animal xenografts. Naltrexone (NTX) is a general oioid receptor antagonist that results in compensatory elevation in endogenous oioids and opioid receptors. It has a powerful inhibition of cell lproliferation. Studies showed that LDN could also increase the effects of chemotherapy for ovarian cancer.

Thursday      July 28, 2011

New Data on Placebo

Harvard studies published in the NEJM the impact of two placebo treatments vs standard medical treatments for asthma patients. When it came to patient reported benefits, placebos were equally as effective as sthe standard treatment. However, the measured benefits of placebo on pulmonary function testing was only about 35% as effective as standart medical treatments. 

A second study measured the placebo effect vs echinacea vs no treatment showed that both echinacea and placebo made people feel better faster. They concluded that what people believe about their medicines is what matters!

Friday         July 29, 2011

Does Teflon Cause Osteoarthritis?

High blood levels of a chemical (PFOA) found when Teflon is heated to high temperatures was associated with a 40% increased risk for developing osteoarthritis. A second chemical also found in the contaminated water, PFOS, was associated with a 25% lower risk of osteoarthritis! It is hard to know when a chemical contamination will cause a health issue. PFOA has a long biological half life.

Prescriptions for Health Radio Show: Fastrack Archives

This archive is a work in progress. At the end of every week, the most recent editions of Prescriptions for Health, Fastrack edition, will be posted on the DoctorSaputo.com Radio page. Shows from the previous week are then archived. There can be as many as 40 shows archived for a month.

Fastrack Archive January 2011

Fastrack Archive Febuary 2011

Fastrack Archive March 2011

Fastrack Archive April 2011

Fastrack Archive May 2011

All "Fastrack" Archives starting in June are in video!

Fastrack Archive June 2011

Fastrack Archive August 2011

Fastrack Archive September 2011

Fastrack Archive October 2011