Archive for March 21st, 2012
Take a look. The 10 falsehoods:
Again: each statement below is false.
No Pain, No Gain
Soreness After Exercise is Caused by Lactic Acid Building Up in Your Muscles
Exercise Takes Long Hours/Is Worthless If I Can’t Exercise Regularly
You Need a Sports Drink When Exercising to Replenish Your Body’s Electrolytes/Minerals/Etc
Stretching Before Exercise Will Prevent Injury
Working Out Will Only Build Muscle, Not Help Me Lose Weight
Exercise Will Help Me Lose Weight Quickly
You Need to Take Supplements to Build Muscle
If You Don’t Exercise When You’re Young, It’s Dangerous When You Get Older
If you click the link above, it won’t take you to the article.
Donald McNeil, Jr., reports in the NY Times:
For months, a simple generic drug has been saving lives on America’s battlefields by slowing the bleeding of even gravely wounded soldiers.
Even better, it is cheap. But its very inexpensiveness has slowed its entry into American emergency rooms, where it might save the lives of bleeding victims of car crashes, shootings and stabbings — up to 4,000 Americans a year, according to a recent study.
Because there is so little profit in it, the companies that make it do not champion it.
However, the drug is edging slowly closer to adoption as hospitals in New York and other major cities debate adding it to their pharmacies. The drug, tranexamic acid, has long been sold over the counter in Britain and Japan for heavy menstrual flow. After a groundbreaking 2010 trial on 20,000 hemorrhaging trauma patients in 40 countries showed that it saved lives, the British and American Armies adopted it. The World Health Organization added it to its essential drugs list last year, and British ambulances now carry it.
But outside Britain, it is used in very few civilian hospitals, though almost six million people around the world die each year of trauma — 400,000 of them in hospitals. A studypublished March 1 in BMC Emergency Medicine estimated that the drug could save up to 128,000 of those lives a year, 4,000 of them in the United States.
The slowness of American hospitals is due to . . .
Continue reading. The author quotes one doctor as saying the problem is “inertia,” which begs the question: that’s not an answer, it’s just a different word for saying that hospitals are not moving to adopt it. But why not? Reason: In the US medical treatment is a profit-oriented business, and like all such businesses, the constant drive of the institutions and businesses is to grow profits. As noted many times, a modern corporation is legally obligated to put profit considerations first (or face shareholder lawsuits for abdication of fiduciary responsibility). Unfortunately, profit considerations don’t always work well for every situation, and here we see a drug that could save lives by the millions being rejected—or at least not adopted—because the profit potential is so low. So you die? So what? The hospital must make a profit or it will not be able to function, so let that be your consolation.
But maybe—just maybe—the profit model is not the only model to use?
But even then one must face the pig-headed obstinacy of the stupid—Dr. Holcomb, for example, who rejects findings of clinical trials because… well, because he can, I guess. So what if patients die? Not his problem.
UPDATE: It occurs to me that Dr. Holcomb offers an excellent example of how ideology overrides evidence for some people: a study of 20,000 people shows no side effect, but Dr. Holcomb rejects the study out of hand (and, presumably, without so much as a glance at the data) because he has his convictions and those he will keep even if he must ignore conflicting evidence. Much easier for him.
I continue to find Scotch whisky interesting and somewhat baffling. (I’m tasting single-malt scotches via a gift of samplers from The Wife.) First the tastes are much more complex than (say) bourbon: more like wine or EVOO (the real stuff) or some other such product. And different single-malts (like different wines and different EVOOs) can have startlingly different flavors and tastes. And even a particular scotch seems to taste differently depending on what else I’ve eaten. Hard to fathom.
Perhaps this will help: Tasting Scotch Whisky, Note By Vacuum-Distilled Note.
Last night my feet and calves were sort of itchy: bad sign for diabetics (could be circulation and/or neuropathy problems, both of which diabetics are prone to have). I can hear a wake-up call as well as the next guy, so today I walked to the library to pick up a book on hold (Barbara Tuchman’s March of Folly to better understand why certain political leaders think another war, this one with Iran, is a good idea). Normally the walk is 20 min each way, 40 min total. Today, with about a 5-minute rest at the library, it took an hour. So probably good to get out and about daily.
My Fitbit was encouraging. I actually climbed two flights of stairs, but I got credit for 13 because apparently climbing a steep hill is counted as climbing stairs—and I’m okay with that. Here’s the display right now:
I was tempted to stop by the sushi place for a small treat, but when I got to the library, I realized I’d have to walk 3 block farther (and 3 blocks back), so quickly lost interest. Just as well.
An editorial in today’s NY Times:
As he rolled out his 2013 budget on Tuesday, Paul Ryan, the House Budget Committee chairman, correctly said that he and his fellow Republicans were offering the country a choice of two very clear futures. The one he outlined in his plan could hardly be more bleak.
It is one where the rich pay less in taxes than the unfairly low rates they pay now, while programs for the poor — including Medicaid and food stamps — are slashed and thrown to the whims of individual states. Where older Americans no longer have a guarantee that Medicare will pay for their health needs. Where lack of health insurance is rampant, preschool is unaffordable, and environmental and financial regulation are severely weakened.
Mr. Ryan became well known last year as the face of the most extreme budget plan passed by a house of Congress in modern times. His new budget is, if anything, worse, full of bigger, emptier promises. It is largely in agreement with the plans of the Republican presidential candidates.
It vows to balance tax cuts for corporations and the rich by closing loopholes, but never lists the loopholes. It is, however, quite specific about cutting Medicaid by about 45 percent, leaving 19 million people without care, and eliminating plans to provide health insurance for 33 million who lack coverage now.
Worst of all, it undermines a hard-fought agreement Democrats and Republicans made last August to set spending targets for 2013. Under pressure from House conservatives, Mr. Ryan cut nearly $20 billion from spending levels set in the debt-ceiling pact, breaking faith with the Senate and potentially leading to a government shutdown this fall. Much of that reduction is likely to come from programs like Head Start, Pell grants for college students and state aid.
It also tries an end run around an agreement Republicans signed last year to reduce the deficit over 10 years with equal $55 billion annual cuts to military and domestic programs after the Congressional supercommittee failed to agree on a plan. Mr. Ryan wants to increase defense spending and shift all the cuts to domestic programs, which will probably include food stamps, the federal payroll and mortgage guarantees. Very little of Mr. Ryan’s plan will get through the Senate, but it sets a disturbing precedent for future agreements.
Over all, about half of Mr. Ryan’s $5 trillion in cuts over a decade would come from health care. His plan to convert Medicare to a “premium support” system, though less damaging than last year’s proposal, still weakens a guarantee to the elderly and risks driving up costs for future beneficiaries. He would still offer the elderly a fixed amount of money to shop for their own health insurance, but allow the option of enrolling in traditional Medicare.
Unfortunately, that could lead to higher costs and premiums in traditional Medicare because it would attract older and sicker patients who would be expensive to cover, while healthier, cheaper patients flocked to private plans. In the long run, the premium support plan could shift costs to beneficiaries because it would limit annual per capita spending growth to well below the level required by the health care reform act. The plan would also cap the federal contribution to Medicaid by turning the program into a block grant to states.
These extreme cuts and changes would greatly impede the nation’s economic recovery, and hurt those on the middle and lower economic rungs who suffered most from the recession. The contrast with President Obama’s budget, which raises taxes on the rich to protect vital programs while reducing the deficit, could not be more clear.
Interesting. I’d like Congress to fix this, but Congress is unresponsive these days. Katie Thomas reports in the NY Times:
Debbie Schork, a deli worker at a supermarket in Indiana, had to have her hand amputated after an emergency room nurse injected her with an anti-nausea drug, causing gangrene. She sued the manufacturer named in the hospital’s records for failing to warn about the risks of injecting it. Her case was quietly thrown out of court last fall.
That result stands in sharp contrast to the highly publicized case of Diana Levine, a professional musician from Vermont. Her hand and forearm were amputated because of gangrene after a physician assistant at a health clinic injected her with the same drug. She sued the drug maker, Wyeth, and won $6.8 million.
The financial outcomes were radically different for one reason: Ms. Schork had received the generic version of the drug, known as promethazine, while Ms. Levine had been given the brand name, Phenergan.
“Explain the difference between the generic and the real one — it’s just a different company making the same thing,” Ms. Schork said.
Across the country, dozens of lawsuits against generic pharmaceutical companies are being dismissed because of a Supreme Court decision last year that said the companies did not have control over what their labels said and therefore could not be sued for failing to alert patients about the risks of taking their drugs.
Now, what once seemed like a trivial detail — whether to take a generic or brand-name drug — has become the deciding factor in whether a patient can seek legal recourse from a drug company. The cases range from that of Ms. Schork, who wasn’t told which type of drug she had been given when she visited the hospital, to people like Camille Baruch, who developed a gastrointestinal disease after taking a generic form of the drug Accutane, as required by her health care plan.
“Your pharmacists aren’t telling you, hey, when we fill this with your generic, you are giving up all of your legal remedies,” said Michael Johnson, a lawyer who represented Gladys Mensing, one of the patients who sued generic drug companies in last year’s Supreme Court case, Pliva v. Mensing. “You have a disparate impact between one class of people and another.”
The Supreme Court ruling affects potentially millions of people: nearly 80 percent of prescriptions in the United States are filled by a generic, and most states permit pharmacists to dispense a generic in place of a brand name. More than 40 judges have dismissed cases against generic manufacturers since the Supreme Court ruled last June, including some who dismissed dozens of cases consolidated under one judge.
Public Citizen, a consumer advocacy group, has petitioned the Food and Drug Administration to give generic companies greater control over their labels, a rule change that could allow users of generic drugs to sue, but the agency said earlier this month that it needed more time to decide. “Congress can make this problem go away, and the F.D.A. could, too,” said Allison Zieve, the director of Public Citizen Litigation Group. “But we haven’t seen signs that either of them is paying much attention.” A spokeswoman for the F.D.A. declined to comment.
The Supreme Court’s ruling, which was split 5 to 4 on ideological lines, . . .
Continue reading. Guess whose side the Republicans were on…
I take 81mg aspirin daily (the “aspirin regimen” size) as most diabetics do: help with heart disease, which my cardiologist tells me is what finally gets most diabetics. But it turns out to be good as a cancer preventative as well. Roni Rabin reports in the NY Times:
Taking aspirin every day may significantly reduce the risk of many cancers and prevent tumors from spreading, according to two new studies published on Tuesday.
The findings add to a body of evidence suggesting that cheap and widely available aspirin may be a powerful if overlooked weapon in the battle against cancer. But the research also poses difficult questions for doctors and public health officials, as regular doses of aspirin can cause gastrointestinal bleeding and other side effects. Past studies have suggested that the drawbacks of daily use may outweigh the benefits, particularly in healthy patients.
One of the new studies examined patient data from dozens of large, long-term randomized controlled trials involving tens of thousands of men and women. Researchers at the University of Oxford found that after three years of daily aspirin use, the risk of developing cancer was reduced by almost 25 percent when compared with a control group not taking aspirin. After five years, the risk of dying of cancer was reduced by 37 percent among those taking aspirin.
A second paper that analyzed five large randomized controlled studies in Britain found . . .