This is from a French study on NSAIDS, but does point out another problem for non-steroidal anti-inflammatory drugs. They say that use of NSAIDs in the early stages of severe lower respiratory tract infection may be causing additional problems for pneumonia patients.
In the pilot study, they observed that NSAID treated patients with community-acquired pneumonia were five times more likely to develop pleural empyema or lung cavitation, that is the this transparent membrane enveloping the lungs and lining the walls of the thoracic cavity. This is compared to patients not receiving NSAIDs.
The authors did say that patients who were taking NSAIDs did not have higher rates of organ failure, nor a greater need for organ support or more severe systemic inflammation while in the ICU, nor did the mortality rare differ between the groups.
They also say these finding suggest that NSAID use at the early stage of community-acquired pneumonia can be associated with less effective compartmentalization of infection, and a blunted systemic response, which may result in a delayed diagnosis and management, and a protracted course of treatment.
Read the article about this here.
12 February 2011
11 February 2011
Fast Food Advertising Dangerous to Health
How do you feel with the barrage of fast food advertising we are getting in our faces every day? I know I don't appreciate it, and for a variety of reasons. There are others that are writing about this and many studies showing the problems of fast food on our psyche.
Although this is not fast food, it is added to fast foods in generous quantities. I am talking about high fructose corn syrup which has changed its name to corn sugar. In general, depending on the programs that I view on TV, I often see their advertising two more more times per evening.
While sugar may be sugar as they advertise it, corn sugar is very dangerous for those of us with diabetes. But of course this is not mentioned in the advertising, nor do they mention all the foods that corn sugar is added to when it is not needed. Corn sugar does not need to be part of the foods, but the corn industry wants us to believe it is not dangerous for those of us with diabetes as it is just sugar. What makes this so deceptive is that as they make this statement of sugar is sugar, an adult is always reaching down and picking up a child as if to say, they know best for their child's food safety. I don't think so!
Jon Barron has a lengthy article about junk food and the extremes that some of the companies use to convince people how good their junk foods are. I will let you read his article here. I agree with what he is saying and followed some of his links so see how deceptive some of the sites are, and they are very deceptive in luring our youngsters in and giving them something to do.
Then you know that the young people will want their parents to take them to these places. Jon does an excellent job of laying out how our government is subsidizing the corn industry and helping them promote corn sugar. Even my wife is now learning how to read labels and avoiding HFCS and related products when they say corn solids and corn additives.
We both are avoiding more and more foods that are loaded with additives and junk food ingredients. We are spending more time in the fresh fruit and vegetable section and less time in the rest of the grocery isles.
Another blog about the grocery isles and problems in the rest of our world is this by Pine Pienaar of South Africa.
Although this is not fast food, it is added to fast foods in generous quantities. I am talking about high fructose corn syrup which has changed its name to corn sugar. In general, depending on the programs that I view on TV, I often see their advertising two more more times per evening.
While sugar may be sugar as they advertise it, corn sugar is very dangerous for those of us with diabetes. But of course this is not mentioned in the advertising, nor do they mention all the foods that corn sugar is added to when it is not needed. Corn sugar does not need to be part of the foods, but the corn industry wants us to believe it is not dangerous for those of us with diabetes as it is just sugar. What makes this so deceptive is that as they make this statement of sugar is sugar, an adult is always reaching down and picking up a child as if to say, they know best for their child's food safety. I don't think so!
Jon Barron has a lengthy article about junk food and the extremes that some of the companies use to convince people how good their junk foods are. I will let you read his article here. I agree with what he is saying and followed some of his links so see how deceptive some of the sites are, and they are very deceptive in luring our youngsters in and giving them something to do.
Then you know that the young people will want their parents to take them to these places. Jon does an excellent job of laying out how our government is subsidizing the corn industry and helping them promote corn sugar. Even my wife is now learning how to read labels and avoiding HFCS and related products when they say corn solids and corn additives.
We both are avoiding more and more foods that are loaded with additives and junk food ingredients. We are spending more time in the fresh fruit and vegetable section and less time in the rest of the grocery isles.
Another blog about the grocery isles and problems in the rest of our world is this by Pine Pienaar of South Africa.
10 February 2011
Be Careful What Anti-Inflammatory Drugs You Use!
I don't regularly use any of these pain relievers, but I am surprised by this study. It is really another warning about non-steroidal anti-inflammatory drugs or NSAIDs. They are showing that they have cardiovascular risks higher than previously thought. This is not good and is encouraging more investigation – which may lead to more being removed from the market.
It would seem that these would have been safe, but more studies are showing that they are not as safe as we would like. And even the some of the more common pain relievers are now being found unsafe. This is a blow to many of us with diabetes that wish to avoid using steroids to relieve pain for some conditions.
Prior meta-analyses did not resolve the debate as they failed to include all the available evidence. This new network meta-analysis which is published online, January 11, 2011 in the British Medical Journal, includes all available evidence.
Investigators expected to see an increased risk but was surprised by the magnitude of the signal. Also they cited that the doses were high, they felt that this was clinically relevant. Investigators admitted they were shocked by the two and four-fold increase of risks. This new study, by including all 31 trials and over 116,000 patients, were able to see the increase in patients taking naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, lumiracoxib, rofecoxib, or placebo.
The authors recommend that physicians use special care to evaluate patients prone to cardiovascular problems and use NSAIDs at the lowest possible dose and for as short a period as possible. They also would like to see black box warnings added to all products still available on the market.
Although naproxen seemed the least harmful in this study, there are major concerns about the gastrointestinal safety of the drug. Because it is necessary to add another drug to protect the stomach, this is not an ideal drug. It requires determining the benefits and risks.
Until further studies are completed, it may be necessary for physicians to carefully evaluate patients for the benefits and risks of NSAIDs and limit their use when possible.
Read the article about NSAIDs here.
It would seem that these would have been safe, but more studies are showing that they are not as safe as we would like. And even the some of the more common pain relievers are now being found unsafe. This is a blow to many of us with diabetes that wish to avoid using steroids to relieve pain for some conditions.
Prior meta-analyses did not resolve the debate as they failed to include all the available evidence. This new network meta-analysis which is published online, January 11, 2011 in the British Medical Journal, includes all available evidence.
Investigators expected to see an increased risk but was surprised by the magnitude of the signal. Also they cited that the doses were high, they felt that this was clinically relevant. Investigators admitted they were shocked by the two and four-fold increase of risks. This new study, by including all 31 trials and over 116,000 patients, were able to see the increase in patients taking naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, lumiracoxib, rofecoxib, or placebo.
The authors recommend that physicians use special care to evaluate patients prone to cardiovascular problems and use NSAIDs at the lowest possible dose and for as short a period as possible. They also would like to see black box warnings added to all products still available on the market.
Although naproxen seemed the least harmful in this study, there are major concerns about the gastrointestinal safety of the drug. Because it is necessary to add another drug to protect the stomach, this is not an ideal drug. It requires determining the benefits and risks.
Until further studies are completed, it may be necessary for physicians to carefully evaluate patients for the benefits and risks of NSAIDs and limit their use when possible.
Read the article about NSAIDs here.
09 February 2011
Much TODO About the Florida Ruling
At least one medical blogger has it right about the Affordable Care Act. Bob Doherty has a good blog on February 2, 2011 and addresses the issues. Of medical bloggers, he does very well in not being impassioned on either side of the issue. He does stick to the facts. Some of the commentors seem very passionate about the issues.
This makes some sense and explains some of the news I heard on the first and second day. Since I do not trust much of the media, I have been hesitant to continue writing about much of the Affordable Care Act (ACA) until the issue has been clarified.
Since the Obama administration has seemed fit to brush aside the court, and continue as if nothing has happened, it may be wise to understand what is at stake. We know that much of the funding for ACA will not make it through congress. This leaves me to wonder how the administration is going to divert funds to keep things in motion. There is a large sum of prior funds that is not accounted for and may be available.
I know that many of the 26 states involved with this lawsuit are considering requesting this go directly to the Supreme Court. Since I do not have the legal expertize, all I can say is that I hope it will need to take its time in the courts. This issue needs to be fresh in the minds of voters in the 2012 election.
Bob Doherty does ask some pointed questions, and most commentors do not address them directly. The medical community does need to be concerned, and Doherty does address some of the issues, but I think wisely does not try to solve them. These may be for for future blogs for him.
Read his blog here and follow several of his links as they do provide some answers.
This makes some sense and explains some of the news I heard on the first and second day. Since I do not trust much of the media, I have been hesitant to continue writing about much of the Affordable Care Act (ACA) until the issue has been clarified.
Since the Obama administration has seemed fit to brush aside the court, and continue as if nothing has happened, it may be wise to understand what is at stake. We know that much of the funding for ACA will not make it through congress. This leaves me to wonder how the administration is going to divert funds to keep things in motion. There is a large sum of prior funds that is not accounted for and may be available.
I know that many of the 26 states involved with this lawsuit are considering requesting this go directly to the Supreme Court. Since I do not have the legal expertize, all I can say is that I hope it will need to take its time in the courts. This issue needs to be fresh in the minds of voters in the 2012 election.
Bob Doherty does ask some pointed questions, and most commentors do not address them directly. The medical community does need to be concerned, and Doherty does address some of the issues, but I think wisely does not try to solve them. These may be for for future blogs for him.
Read his blog here and follow several of his links as they do provide some answers.
08 February 2011
Assessing the Value of Medical Interventions
This article raises some very ethical questions and in addition may make some barriers to medical care rationing fall. There can be some very cost-effective medical interventions that are also thrown out. And if in the process, doctors consider that the cost-effectiveness is not applicable, what are we as patients to do?
It is true that our views as patients will vary and often differ from the medical professions perspective, but there needs to be a common ground that is not evidence-based (pure theory) in the decisions.
The American College of Physicians (ACP) published the guidelines in the February 1, 2011 issue of the Annals of Internal Medicine. They have outlined key steps to assess the value of medical interventions. Such measures could help to lower the cost of healthcare by eliminating low-value interventions and preserving high-value interventions. The challenge will be to decrease costs while preserving high-value, high-quality care.
Even they have concerns about restrictions on healthcare spending that will lead to more rationing, but they seem locked into cost-benefits analysis. What I get is that this analysis effort in itself can be expensive and is not always allowed in the expense of making the determination.
They have some examples which I am sure will meet with resistance, but much of this will probably be difficult to determine. Also the factor of third party intervention, that is the medical insurance industry, will they work with this and allow for some procedures that have high benefits at lower costs. We know that Medicare will not always be on board from some of their policies. See this about Medicare.
Not mentioned is preventive care which could have very high benefits and low cost. I am talking about screening for diabetes and working with these patients to delay the onset of full and costly diabetes. This may be part of the picture, but it is doubtful that the medical insurance industry will allow for this even though it could be very cost effective for them as well. Presently, it the diagnosis is prediabetes, there is no medical reimbursement. This needs to change as well.
Will the medical community work for these benefits? At present, this seems very doubtful, even if there is a lot of call for this.
Read the article in full here.
It is true that our views as patients will vary and often differ from the medical professions perspective, but there needs to be a common ground that is not evidence-based (pure theory) in the decisions.
The American College of Physicians (ACP) published the guidelines in the February 1, 2011 issue of the Annals of Internal Medicine. They have outlined key steps to assess the value of medical interventions. Such measures could help to lower the cost of healthcare by eliminating low-value interventions and preserving high-value interventions. The challenge will be to decrease costs while preserving high-value, high-quality care.
Even they have concerns about restrictions on healthcare spending that will lead to more rationing, but they seem locked into cost-benefits analysis. What I get is that this analysis effort in itself can be expensive and is not always allowed in the expense of making the determination.
They have some examples which I am sure will meet with resistance, but much of this will probably be difficult to determine. Also the factor of third party intervention, that is the medical insurance industry, will they work with this and allow for some procedures that have high benefits at lower costs. We know that Medicare will not always be on board from some of their policies. See this about Medicare.
Not mentioned is preventive care which could have very high benefits and low cost. I am talking about screening for diabetes and working with these patients to delay the onset of full and costly diabetes. This may be part of the picture, but it is doubtful that the medical insurance industry will allow for this even though it could be very cost effective for them as well. Presently, it the diagnosis is prediabetes, there is no medical reimbursement. This needs to change as well.
Will the medical community work for these benefits? At present, this seems very doubtful, even if there is a lot of call for this.
Read the article in full here.
07 February 2011
Are Physicians Sometimes Rotten Apples?
This is an unusual blog post for Trisha Torrey, but I agree with her on this one. We do have to many doctors that are bad apples and they are spoiling the basket for the rest. The state boards that constantly refuse to oust them and take away their licenses also need review, but Trisha does not cover this.
I had thought to pass on this until an article from Medscape made the scene on January 28, 2011. This article is from an investigation in Philadelphia, PA in which a Pennsylvania grand jury returned an a verdict that is bound to have the medical community shaking in their boots. Talk about a rotten apple doctor, to say nothing about the state offices and city offices that let this continue because of their inaction. This is officialdom at its worst and hopefully people will be dismissed for their lack of action.
Sad to say, this is probably just the tip of the iceberg and there are many other doctors that should have had their licenses revoked or suspended for investigation across the US. So while Trisha's blog was timely, it is articles like Medscape's that may get some federal and state agencies off their backsides and into action.
This is another reason for patient empowerment and better whistle blower laws to have people ready to report more of this without fear of losing their jobs. This also points out another case on Texas where two nurses are finally having their day for whistle blowing and county officials having to pay for protecting a doctor. And this time it is the doctor who is also in trouble.
This is one time Trisha has my full support in her call to weed out the doctors that are creating a bad name for their profession. Even the good and caring doctors should be behind this and want them out of practice. We have too many good doctors that are being tainted by the news of these horrifically bad physicians.
Please carefully read Trisha's blog here. She makes some astute observations about the catch-22 situation and how to work out of it with dignity. My take is even though she is talking to the doctors, some of this can apply to the patients in realizing how they come across when they have had bad experiences with one doctor and are very reserved of the doctor they are now seeing.
Read about the Pennsylvania doctor here and the Texas case here. Like I said earlier, I believe this is just the tip of a much larger problem within the medical profession.
And Trisha is not finished – on February 1, 2011, she has more information about the doctors of questionable character. So enjoy reading and this is educational and if doctors and state boards and others do not act, then it is time for us to speak with our checkbooks.
I had thought to pass on this until an article from Medscape made the scene on January 28, 2011. This article is from an investigation in Philadelphia, PA in which a Pennsylvania grand jury returned an a verdict that is bound to have the medical community shaking in their boots. Talk about a rotten apple doctor, to say nothing about the state offices and city offices that let this continue because of their inaction. This is officialdom at its worst and hopefully people will be dismissed for their lack of action.
Sad to say, this is probably just the tip of the iceberg and there are many other doctors that should have had their licenses revoked or suspended for investigation across the US. So while Trisha's blog was timely, it is articles like Medscape's that may get some federal and state agencies off their backsides and into action.
This is another reason for patient empowerment and better whistle blower laws to have people ready to report more of this without fear of losing their jobs. This also points out another case on Texas where two nurses are finally having their day for whistle blowing and county officials having to pay for protecting a doctor. And this time it is the doctor who is also in trouble.
This is one time Trisha has my full support in her call to weed out the doctors that are creating a bad name for their profession. Even the good and caring doctors should be behind this and want them out of practice. We have too many good doctors that are being tainted by the news of these horrifically bad physicians.
Please carefully read Trisha's blog here. She makes some astute observations about the catch-22 situation and how to work out of it with dignity. My take is even though she is talking to the doctors, some of this can apply to the patients in realizing how they come across when they have had bad experiences with one doctor and are very reserved of the doctor they are now seeing.
Read about the Pennsylvania doctor here and the Texas case here. Like I said earlier, I believe this is just the tip of a much larger problem within the medical profession.
And Trisha is not finished – on February 1, 2011, she has more information about the doctors of questionable character. So enjoy reading and this is educational and if doctors and state boards and others do not act, then it is time for us to speak with our checkbooks.
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