When There is No Evidence - And Marketing Drugs

I came across o couple of interesting news articles. Many treatments physicians perform have no real evidence of usefulness. Just like the "logic" that lowering cholesterol must prevent heart diseases (as we know certain drugs do not help), many procedures have no proven benefit.

My comments on the Atlantic Monthly Article:

Concerning stents, there are some locations in the heart where stents do prevent death. The problem is that placing a stent has become a knee jerk reaction, and is often unnecessary. It can be a difficult decision.

Beta blockers, like atenolol, have their place, but they have never been first line in high blood pressure. The studies have not addressed whether, as an add-on, they are worthwhile. When they are the third choice to lower pressure they may be needed. They also have many other, non-cardiac, uses.

The second article just reinforces what I have been saying for a long time about big Pharma!

Atlantic Article

Pharma Article

Influenza Activity and Vaccine 2017

The CDC has reported that 23 states — including nearly all of the South and parts of the Northeast — are seeing flu activity that is much higher than average.

Five children and teens died from the flu in the last week recorded, bringing the total number for the 2016–17 flu season up to 20. The proportion of pediatric deaths due to pneumonia and influenza (7.9%) reached an epidemic threshold in late January.

The predominant circulating strain is influenza A (H3), which is covered under the current flu vaccine. Virus samples tested are susceptible to antivirals like Tamiflu.

https://www.cdc.gov/flu/weekly/

The good news is that the flu vaccine is almost 50% effective against circulation strains. Because the vaccine takes several months to produce in adequate amounts, the CDC decides in spring (May 2016) which strains should be included in this year's vaccine. This is typically based on what is circulating in the far East. In some years they have been wrong, with the vaccine being only effective against as low as 20% of strains. Ideally 75% is the goal; but even 50% is great and saves lives.

Given that influenza activity remained high as of February 10, the CDC recommends vaccinating unvaccinated individuals aged 6 months and older "as soon as possible." As I have previously mentioned I agree with this.

Infuenza Vaccine 2016-2017

After my vaccination post I have had a few questions about the flu vaccine. Bottom line is that we should be getting the vaccine. In fact, in the CDC weekly report, we find that activity is very high this year, but mainly with virus strain present in this years vaccine. Five children and adolescents died from the flu in the last week recorded, bringing the total number for the 2016–17 flu season up to 20. The proportion of pediatric deaths due to pneumonia and influenza (7.9%) reached an epidemic threshold in late January.

https://www.cdc.gov/flu/weekly/

Studies have shown that flu vaccine helps prevent deaths and serious complications; in fact it may even prevent non-influenza upper respiratory infections. The two most recent studies reveal that seasonal influenza epidemics in the United States are responsible for between 55,000 and 431,000 hospitalizations due to pneumonia and influenza each year and as many as 49,000 deaths.

Zhou H, Thompson WW, Viboud CG, et al. Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008. Clin Infect Dis 2012;54:1427-1436

Reed C, Chaves SS, Daily Kirley P, et al. Estimating influenza disease burden from population-based surveillance data in the United States. PLoS One 2015;10:e0118369-e0118369

In many articles the vaccine has been shown to radically decrease the rates of infection - 59% in children, seniors and pregnant women (high risk for complications); as well as in all adults.

N Engl J Med 2013; 369:2481-2491
N Engl J Med 2014; 371:635-645
N Engl J Med 2014; 371:918-931

The main side effect has been pain at injection site. There is no association between the shot and getting sick. There is a very slight increased risk of Guillan Barre syndrome; but this is far less than the risk with influenza itself.

The vaccine is prepared 6 months in advance, and scientits try to assess what strains will be in this year's infections. In some years they have missed, with the efficacy as low as 25%. That still has some effect. This year they seem to have hit the correct ratio.

Vaccinations

The appointment of an anti-vaccine advisor in new cabinet has led to ripples of concern in the medical community. Anyone old enough to have experienced the childhood illnesses they prevent cringes when they recall the polio epidemic, with its resulting deaths and paralysis (aside from the closing of schools and keeping children indoors). Deaths fro measles, diphtheria, whooping cough, etc are now a thing of the past, And we need to keep it that way.

Recently there was another outbreak of measles. Although 90% of the cases occurred in vaccinated children, these kids had almost no complications; vaccination prevented deaths and disability.

A couple of recent studies confirms their benefits.

In Pediatrics 2015 May 4, Investigators from the CDC reviewed all confirmed and probable pertussis (whooping cough) cases in the U.S. from 1991 to 2008 in infants aged <365 days and assessed the role of vaccination in preventing pertussis-related deaths. They found that even one dose, given at 6 weeks (rather tha the recommended 2 months) during outbreaks, prevented 68 deaths. And as expected, unimmunized children at any age were at the greatest risk of death.

In another story, Reuters reported on a very severe late complication of measles, called Subacute sclerosing panencephalitis (SSPE). This is more common than suspected, perhaps in 1 in 1300 cases. Although that may sound uncommon, in non-vaccinated individuals there is a 90% chance of catching measles after exposure. If no children were immunized there could be thousands of deaths.

Get your kids immunized. There is no place today for those espousing "alternative facts".

http://www.reuters.com/article/us-health-measles-idUSKCN12S226

Genetically Modified Enzymes

There has been much controversy over genetically modified (GMO) foods. at this time there has been no conclusive evidence that these foods are bad for you, but there are many unanswered questions.

But gene modification is not unique to foods. Genetically modified enzymes are used increasingly to create flavors and fragrances and to enhance the strength of detergents and medications.

Now researchers are finding that workers in these industries are developing allergies and asthma because of this. Researchers tested blood samples for allergy antibodies from some 800 people exposed to enzymes in factories where they work. Roughly one-quarter of participants tested positive for antibodies against their particular workplace enzymes. Of these, about 17% reported asthma symptoms and 19% reported itchy eyes and running noses associated with their jobs. Cleaning and home care products were the worst.

Original Article

Clearly more testing is required in the use of genetically modified material. 

Money Drugs and Cholesterol

We all know that drug companies are very profitable, and often will use anything to promote their products; even if ineffective.

Many physicians obtain their information about new drugs from drug reps (most often very attractive and flirtatious) rather than academic sources.

About 10 years ago researchers began to question how cholesterol lowering drugs actually work. There is very good evidence that the statins (Lipitor, etc) can lower the risk of heart attacks. But they began to discover that other drugs, such as Zetia, Tricor and Niacin may lower your cholesterol, but not affect the risk heart disease. It seems that the statins work in different ways (the current thinking is an anti inflammatory effect)

So why are these essentially useless, and sometimes dangerous drugs, still on the market? In my opinion it comes down to profit for drug companies and doctors keeping up with their reading.

In a recent study, JAMA Cardiol 2016 Dec 28, researchers again confirmed that fenofibrate does not prevent heart disease, but also has an unacceptable side effect profile - higher risk of heart attacks and strokes! Yet it is still used! The FDA should have really taken it off the market! I still see patients on it; and sometimes their primary care doctors or cardiologists get defensive about it!

And, when a new drug is effective, the drug companies have been pricing them as high as possible; to make them not cost effective! There is a new category of cholesterol lowering medication, the PCSK9 inhibitors which lower LDL cholesterol as well as lowering the risk of heart attacks. However, at the wholesale cost of $15,000 per year, the cost of preventing one death is about $500,000. This is considered not cost effective. (JAMA. 2016;316(7):743-753)

One promise President Trump has espoused is negotiating with drug companies. Based on his top heavy big business cabinet this does seem unlikely.

Stealthy sweets

I recently read a Canadian article on sweets in our diet; and it applies in the US as well.

Dextrose, glucose, fructose, fruit juice concentrate – they’re all code names for sugars that are added to our processed food and drinks, but how often? Researchers tested more than 40,000 products sold by one Canadian grocery retailer, and found that a whopping two-thirds contained added sugars. Along with the usual suspects like candy and chocolate were some foods often marketed as healthy options, such as breakfast cereals, granola bars, and fruit juices. And nearly half of all infant formulas and baby food studied included added sugars too. But there’s some bad news if you want to check the label for added sugars: You’ll have to learn the more than 150 ways to say sugar. (click underlined to go to link) Last month, Health Canada announced that new labels won't list added sugars separately, which health professionals and others had wanted.