Saturday, 4 February 2012

The New Pharmaceutical Company Representatives: The Professor Peons

Can we trust Medical Professionals in the employ of Drug Companies to teach us about Drugs?

I just received something in the mail about one of the many new drugs to treat Diabetes, this one a long acting GLP 1 agonist that the patient can use once a week.
So a professor is presenting and enthusiastically endorses her drug, brushing aside the possibilities of Thyroid Cancer and Pancreatitis as side effect:
“I am really excited that we now have another drug and perhaps a drug that for some patients will make adherence easier. Because this is now just a once-a-week injection.” This is Dr A… P for MEDSCAPE.

As is my custom, now jaded by listening to professor peons of the pharma industry, I looked up whether or not she was in the employ of the manufacturer of the drug, sure enough.
Served as Director, officer, partner, employee, advisor, consultant or trustee for: Amylin Pharmaceuticals

The very same company that manufactures the drug she is enthusiastically endorses.
Is this ethical?
Or is this just the way of life in this postmodern world?
My title for them Professor-Peons is a good designation indeed!
The same day ADA EASD recommendations arrived in a slide form

You can expect a reduction in HgA1c of 0.5- 1.0 with GLP agonists…
To put every thing in context we need interventions that would bring down the A1C levels by 2 or 3 in most patients, that is certainly not going to come from medications, or education but what will become a global way of looking after patients with Diabetes: to pay attention to the person who is suffering, find out all the sources of his suffering, not just at his A1C level or Medication list: Psychological/Philosophical counselling, taking into consideration the cultural context. I can say this after working with American Indians in the USA, various native and non-native populations around the world.
Medications account for only 25 % of the treatment of patient with Type 2 DM
Treatment is too sterile a word; Healing would be a better word. So these professor peons can be entrusted with that 25 % and let others take care of the other 75 % and be given the credit they are due!


WebMD owns MEDSCAPE
Which has come under increasing criticism for being a disguise for pharma advertising:
Allegations have been made that WebMD biases readers towards using drugs sold by their pharmaceutical sponsors in cases in which the drug is unnecessary.[12]
In February 2010, Senator Chuck Grassley of Iowa investigated WebMD’s financial relationship with drug maker Eli Lilly.

I personally wouldn't read WebMD magazine nor will I direct my patients towards it and in our clinics, those magazines do not make appearances since we serve poor people and of no economic importance to these glossy magazines and drug representatives.

Thursday, 2 February 2012

HAPPY TO BE AN ENDOCRINOLOGIST

Where to we find enduring love? Answer: Oxytocin. Infidelity? Testosterone. Heartbreak? Low serotonin and endorphins. In fact, our loved ones are actually present in our brains - neurochemically - and when we lose them, it results in chemical trauma for the brain:
Where to we find enduring love? Answer: Oxytocin. Infidelity? Testosterone. Heartbreak? Low serotonin and endorphins. In fact, our loved ones are actually present in our brains - neurochemically - and when we lose them, it results in chemical trauma for the brain:

"An American study of over four thousand men found that husbands with high testosterone levels were 43 percent more likely to get divorced and 38 percent more likely to have extramarital affairs than men with lower levels. They were also 50 percent less likely to get married at all. Men with the least amounts of testosterone were more likely to get married and to stay married, maybe because low testosterone levels make men calmer, less aggressive, less intense, and more cooperative.

"The desire to commit to someone is strongly linked to ... oxytocin. ... Oxytocin is released by the pituitary gland and acts on the ovaries and testes to regulate reproduction. Researchers suspect that this hormone is important for forming close social bonds. The levels of this chemical rise when couples watch romantic movies, hug, or hold hands. Prairie voles [mammals related to the mouse], when injected with oxytocin, pair much faster than normally. Blocking oxytocin prevents them from bonding in a normal way. This is similar in humans, because couples bond to certain characteristics in each other. This is why you are attracted to the same type of man or woman repeatedly. In general, levels of oxytocin are lower in men, except after an orgasm, where they are raised more than 500 percent. This may explain why men feel very sleepy after an orgasm. This is the same hormone released in babies during breast-feeding, which makes them sleepy as well.

"Oxytocin is also related to the feelings of closeness and being 'in love' when you have regular sex for several reasons. First, the skin is sensitized by oxytocin, encouraging affection and touching behavior. Then, oxytocin levels rise during subsequent touching and eventually even with the anticipation of being touched. Oxytocin increases during sexual activity, peaks at orgasm, and stays elevated for a period of time after intercourse. ... In addition, there is an amnesic effect created by oxytocin during sex and orgasm that blocks negative memories people have about each other for a period of time. The same amnesic effect occurs from the release of oxytocin during childbirth, while a mother is nursing to help her forget the labor pain, and during long, stressful nights spent with a newborn so that she can bond to her baby with positive feelings and love.

"Higher oxytocin levels are also associated with an increased feeling of trust. In a landmark study by Michael Kosfeld and colleagues from Switzerland published in the journal Nature, intranasal oxytocin was found to increase trust. Men who inhale a nasal spray spiked with oxytocin give more money to partners in a risky investment game than do men who sniff a spray containing a placebo. This substance fosters the trust needed for friendship, love, families, economic transactions, and political networks. According to the study's authors, 'Oxytocin specifically affects an individual's willingness to accept social risks arising through interpersonal interactions.' ...

"What happens in the brain when you lose someone you love? Why do we hurt, long, even obsess about the other person? When we love someone, they come to live in the emotional or limbic centers of our brains. He or she actually occupies nerve-cell pathways and physically lives in the neurons and synapses of the brain. When we lose someone, either through death, divorce, moves, or breakups, our brain starts to get confused and disoriented. Since the person lives in the neuronal connections, we expect to see her, hear her, feel her, and touch her. When we cannot hold her or talk to her as we usually do, the brain centers where she lives becomes inflamed looking for her. Overactivity in the limbic brain has been associated with depression and low serotonin levels, which is why we have trouble sleeping, feel obsessed, lose our appetites, want to isolate ourselves, and lose the joy we have about life. A deficit in endorphins, which modulate pain and pleasure pathways in the brain, also occurs, which may be responsible for the physical pain we feel during a breakup."

Author: Daniel G. Amen, M.D.
Title: The Brain in Love
Publisher: Three Rivers Press
Date: Copyright 2007 by Daniel G. Amen, M.D.
Pages: 64-68


The Brain in Love: 12 Lessons to Enhance Your Love Life
by Daniel G. Amen M.D. by Three Rivers Press

Wednesday, 1 February 2012

at last something about Poverty and Diabetes

Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes
Hilary K. Seligman, MD, MAS1,2⇓, Elizabeth A. Jacobs, MD, MPP3, Andrea L√≥pez, BS1,2, Jeanne Tschann, PHD4 and Alicia Fernandez, MD1
+ Author Affiliations

1Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
2Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
3Division of General Medicine and Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
4Department of Psychiatry, University of California, San Francisco, San Francisco, California
Corresponding author: Hilary K. Seligman, hseligman@medsfgh.ucsf.edu.
Abstract

OBJECTIVE To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes.

RESEARCH DESIGN AND METHODS We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control.

RESULTS The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A1c ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control.

CONCLUSIONS Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.

Footnotes

This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-1627/-/DC1.