What's New ? Yet another Drug withdrawn?

What Now Brown Cow?
Medications can’t cure Illnesses caused by Society
The Case in Point
Obesity

The agency determined that the CV risks outweighed the marginal benefits associated with the drugs and requested that the manufacturer of sibutramine (Meridia, Abbott Laboratories) voluntarily withdraw the product from the market in the U.S. Abbott Laboratories agreed to the request.
The withdraw came after new data from the approximately 10,000-patient Sibutramine Cardiovascular Outcomes (SCOUT) trial indicated a 16% increased risk for major adverse CV events (a composite of nonfatal MI, nonfatal stroke, resuscitation after MI and CV death) in patients taking sibutramine vs. placebo

When these drugs come out, the companies that manufacture them and the doctors who are their spokespeople put such great pressure on harried General Practitioners that you can see a spike in prescriptions. Whenever poor Indians go to the nearest White City to see a doctor, you can be sure he comes back with a prescription for the newest of the medications, much of which we have low opinion of: Byetta, Januvia, Onglyzia etc etc….

What these purveyors fail to point out is the price of meddling with natural processes within the body, which invariably shows up. Meridia, which was touted as the cure for Obesity now comes with a price tag: Death from Cardiovascular Diseases.

In the past few years, I have seen drugs promoted as panaceas withdrawn when the side effects were too numerous to hide or ignore.
You remember, Vioxx? 80 million people took it, prescribed by god fearing, kindhearted medical personnel, before the heart attack and stroke rate became unacceptable.

Lately, there has been a lot of drugs hastily put into market and withdrawn without much fanfare when they were actually killing the patients with other conditions than the ones they were prescribed for. Avandia Rosiglitazone is banned in the European Union and millions of patients are taking them! The death from cardiovascular disease was unacceptable. This is the second in that class category to be withdrawn and the attention centers on Pioglitazone or Actos. I am certain it would be withdrawn in the future.
The hurry to market widely is driven not by scientific evidence or public health priorities. But Profit.
There is no point in pushing Lantus Insulin in Vietnam someone told me, because they wont be able to afford the 30-euro price tag. In the USA, the same insulin is sold for 140 usd, for those poor people who don't have medical insurance. Detemir is another insulin, which promises to be long acting but is definitely short acting very similar to NPH in its action but not in its price. Lantus has been linked to breast cancer and won’t be long before some more abnormalities discovered. What happened to the old fashioned Insulin? They disappear completely to make room for the expensive alternative, which does have only marginal value.
The case in point is the new drugs in the Incretin Mimetics and DPP4 categories. Not a day goes by without some form or another of pharmaceutically backed thinly disguised as academic material, appears in the mailbox, touting their supremacy. But those who practice medicine in real situations know that these medications have an extremely limited value and of course there are complications, including Pancreatitis and now Lung cancer. Makes you wonder, whatever happened to good old-fashioned NPH and Regular Insulin?
It is not the new medications that we require, but a belief that these diseases are caused by the society and the way we are prodded to live, the so-called Life Style. How can we change when we are asked to follow that path? Drink Soft Drinks, movie stars command from their large posters on roadsides in Asia; high fructose corn syrup which is nothing but poison, little girls are sprouting breasts because of Plastics and other chemicals, hypothyroidism is in on the increase because of pesticides containing peroxidase inhibitors…

Please give me a Good Nurse who has the skill of talking and touching and has the desire to take care of her patients, and just Metformin and the old fashioned NPH and Regular Insulin PLUS enough time to talk to patients (minimum of thirty minutes), I can show you better results than any of these multimillion dollar studies….

The World Overweight and Obesity Rates

This publication has generated a lot of attention around the world. A word of warning, BMI is not a good indicator of health in many asian countries, to begin with in the west 25 kg/m2 and below is considered normal whereas in Asia, it would be more like 22 kg/m2. Plus countries in Asia, especially in India, both Type 2 Diabetes and Cardiovascular diseases are seen in thin people, Waist Circumferences or Waist to Hip ratio may be a better predictor.
Photo shows a normal weight Burmese. Malaysia and Singapore are considered the most overweight/obese nations in Asia. Highest rate of Diabetes kudos goes to India and the lowest rate competition may be won by Bhutan, Laos or North Korea (does anyone have data on North Korea?)


Thirty percent of Mexican adults are obese as are 28% of Americans, the two fattest nations in the world, according to a book just published by the OECD (Organization for Economic Co-operation and Development).



OECD obesity rates have risen from well below 10% before 1980 to at least double that amount in most countries, and triple in others. Obesity has climbed up to the top of the public health policy agenda globally, says the OECD. In nearly half of all OECD countries over half the population is overweight or obese.



The OECD is a Paris-based organization, which brings together 33 of the world's leading economies.

http://www.oecd.org/home/0,2987,en_2649_201185_1_1_1_1_1,00.html A very interesting website.





Obesity rates by country (Source: OECD):



* India 1%

* Indonesia 1 %

* China 2%

* Japan 3%

* Korea 4%

* Switzerland 8%

* Italy 10%

* Norway 10%

* Sweden 10%

* France 11%

* Denmark 11%

* Netherlands 12%

* Austria 12%

* Poland 13%

* Brazil 14%

* Israel 14%

* Belgium 14%

* Turkey 15%

* Portugal 15%

* Finland 16%

* OECD average 16%

* Germany 16%

* Slovenia 16%

* Slovak Rep. 17%

* Czech Rep. 17%

* Spain 17%

* Russian Fed. 17%

* Estonia 18%

* Greece 18%

* Hungary 19%

* Luxembourg 20%

* Iceland 20%

* S. Africa 21%

* Chile 22%

* Ireland 23%

* Canada 24%

* UK 25%

* Australia 25%

* New Zealand 27%

* USA 28%

* Mexico 30%

Long Term Exercise and Diet on Control of Diabetes vs Ordinary Care

From Archives of Internal Medicine

Vol. 170 No. 17, September 27, 2010



The investigators, from the Look AHEAD (Action for Health in Diabetes) Research Group, carried out a multicenter, randomized clinical trial which compared the effects of an intensive lifestyle intervention versus diabetes support and education. The study involved 5,145 obese/overweight people with diabetes Type 2 - their average age was 58.7 years.



* Lifestyle intervention ( ILI ) group - 2,570 of them were assigned to a combination of special diet and physical activity. The aim was to get them to lose 7% of their body weight within 12 months - and to keep the weight off for a period of four years. They were contacted by phone and/or seen at least once a month throughout the 48-month period.

* Diabetes support group (DSE) - 2,575 of them received diabetes support and education. They were encouraged to attend three group sessions annually - these sessions focused on such themes as diet, social support and physical activity.



The ILI group was successful in producing sustained weight losses and improvements in cardiovascular fitness through 4 years of follow-up. The ILI group also experienced significantly greater improvements than the usual-care (DSE) group in A1c, HDL, and blood pressure averaged across this period. The ILI group in the Look AHEAD trial is being offered ongoing intervention activities in an effort to sustain the improvements in risk factors. Cost-effectiveness analyses are being conducted.



The critical question is whether the differences between groups in risk factors will translate into differences in the development of CVD. These results will not be available for several additional years.



Conclusions: Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemic control, and CVD risk factors in individuals with type 2 diabetes.

Review on the Book Introduction to Medical Antrhopology

Yesterday I began reading the book, introdution to medical Anthropology by Merrill Singer and Hans Baer
really it is a self aggrandizing, apologetic for their faults and lack of effect. among the three tasks of the book, the first one mentioned was that they are not just ivory tower academics but actually doing something..
the book is not intended for doctors or medical students but other students who would follow their foot steps and set up academic departments and vow to change the world and have absolutely very little effect upon what is happening.
it reminded me very much like the boast of a criminal lawyer in Miami: It is because of us that USA has such a good medical care..
and I feel these authors who are not medical doctors saying..It is because of medical anthropologists things are changing..
reluctantly they mention Arthur Kleinman and Paul Farmer and no mention of Cecil Helman whose book is used in over 60 universities among medical and nursing students...
I put down the book, very dissatisfied and said to myself:
One Paul Farmer is worth ten of these guys..

Days of Magic in San Cristobal del la Habana

Countries cities villages grow on you, some you have a claim to such as being born there and others you find them and more surprisingly some cities or villages find you.. this has been the case for me in the country of Cuba... the big city of La Habana and the pueblocito of Baracoa...
I have put some photos of my second visit this month to Havana, most of which was devoted to work but also for the delightful company of my dear dear friends...

http://picasaweb.google.fr/cochinjew/YehudaHavanneMai2010#

News about Rice and Diabetes from Korea

Korea develops diabetes, atopy-easing rice

Those on a low-carbohydrate diet that includes dramatically reducing portions of their daily rice intake may want to think again.

According to Ryu Su-noh, a professor at Korea National Open University, consuming the rice cultivated through the special method he and his research team discovered could help ease the condition of atopic allergies and even diabetes.

The agriculture scientist this week officially publicly announced the fruits of his 13-year research efforts, even though he had made the discovery three years ago. Ryu said he and his team are the first in the world to develop the three kinds of rice grains - "super jami (pigment)," "daerip jami," and "keunnun jami."

The first breed has the highest amount of cyanidin 3-glucoside (C3G) among the three, carrying 10 times more than the already existing "heuk jinju" rice currently widely known for harboring the highest amount of C3G. The daerip jami carries four times more C3G, while the keunnun jami contains high levels of GABA, or the amino acid gamma-aminobutyric acid, and two to three times more C3G.

According to Ryu's research results, the super jami has the effect of alleviating the symptoms of atopic dermatitis and lowering blood sugar levels. Animal tests showed that consuming the super jami rice could ease itching, or atopic dermatitis, conditions by up to 71 percent.

The super jami could also be a good choice for diabetics because it lowered glucose levels to 43.7 percent, Ryu's animal tests showed. Meanwhile, animals that were fed grapes had sugar levels of 100 percent, while the level came out as 53.5 percent when they were fed standard regular rice.

"The rice grains are not meant to be a treatment, because they are not a form of medicine," Ryu told The Korea Herald in a telephone interview. "These grains are recommended for managing a healthy and nutritious diet and are not for medical purposes."

The food expert also recommended that the special functional rice grains should be consumed by mixing with standard white rice rather than alone.

He said he was able to make a public announcement of his discovery because the research earned credibility by getting published in the Journal of Food Science under the U.S.-based Institute of Food Technologists. The essay on his research was published in last month's issue.

The Journal of Food Science is touted as a respected science journal that covers "peer-reviewed reports of original research and critical review of all aspects of food science," according to the IFT website.

Ryu was quick to note that his rice grains are not a form of genetically modified organism in aims to assure the rice crops are safe for human consumption.

"Our rice grains have no safety issues, and the merits and unique aspects of our rice cultivation technology are that it offers a high production capacity, fosters rice carrying rich health benefits, and is easy for farmers to apply," the professor said.

Ryu's research is backed by the Rural Development Administration, a government-run agency devoted to promoting development of the nation's agriculture industry for economic benefits.

The researcher estimates that cultivation of 330 hectares of the special rice could generate 14.9 billion won in net profit for farmers.

"We believe we could strengthen the global competitiveness of our rice market and thereby help raise our rice farmers' income," the grain specialist said.

Korean farmers of the staple grain are suffering from declining rice consumption amid market opening, and the government is ambitiously aiming to reverse the trend by promoting consumption through the development of rice-based industries. These would include processed rice products like noodles and alcoholic beverages, such as "makgeolli," Korean traditional rice wine.

Interested farmers will be able to take a stab at Ryu's cultivating technology through a contract to buy the special seeds, as the rice grains have been patented.

"We don't plan to provide the seeds to private individuals, but rather only to agricultural cooperatives or farming groups," the agriculture doctor noted.

He said one seed is expected to cost five times more than that of regular white rice.

"We'll have to leave the price to the market once we officially begin supplying the seeds next year."

This would mean consumers will be able to find the super jami, daerip jami and keunnun jami at the market in one to two years, Ryu projected.

"The three rice cultivation technologies have been patented not only in Korea but also Japan and the United States, as we also eventually expect to export the rice abroad," he said.

(sohjung@heraldm.com)

When would this MADNESS stop?

A colleague of mine, whom I respect very much, for his humanitarian approach to Diabetes Care among Native American Indians, forwarded this to me:

See attached original article from Diabetes Care, January 2010 issue.

CONCLUSIONS:

More than 96% of individuals with both IFG and IGT are likely to meet ADA consensus criteria for consideration of metformin.

Because >28% of all those with IFG met the criteria, providers should perform oral glucose tolerance tests to find concomitant IGT in all patients with IFG.

To the extent that our findings are representative of the U.S. population, ~1 in 12 adults has a combination of pre-diabetes and risk factors that may justify consideration of metformin treatment for diabetes prevention.



I wrote to him without delay.
my reaction to this article is pure NAUSEA.. let us keep my reaction to ourselves.. if someone asks about this article we have to have an intelligent discourse . i have embarked on a peer to peer education programme in the Indian country, would send you more details, in which already people who have had diabetes for more than 15 years have come off therapy. Based on articles published, we are too eager to put patients on therapy instead of talking to them and the providers keep on adding medications, such that within a couple of years, a patient with Diabetes in America, ends up with up to five different medications.
As you can see so much bad press about sulfonylureas and there are no drug companies to defend the poor drug, but Actos or Byetta you would see them mounting a multimillion dollar challenge to the published findings.
if we are to follow the published findings
sulfonylurea causes CHF
ACTOS ditto
Byetta pancreatitis
lantus breast cancer

we are left with Metformin, old fashioned Regular and NPH insulin..

thanks, mate

I was happy to receive his reply by return email.
So strange how you read my thoughts – I am obliged to pass along noteworthy findings that come from the medical establishment (such as this one),
but in my heart I feel that we cannot “cure” unhealthy lifestyle, poor personal choices, or the malnutrition of poverty WITH A PILL. The answer is not a drug. Natives in America will never accept this as a solution.

The real answers lie in personal change – education, motivation, and dedication between the patient/client and the health team of the clinic and community.
How we accomplish this paradigm shift in our culture, I do not really know.
Perhaps there will be a cardiovascular crisis in our children and youth – I do not wish to witness such a thing!

Is it true that the King of Tonga once decreed a national initiative for his entire kingdom; all of his people to live healthy, lose weight and eat right?
Maybe one day the leaders of the world can really lead, such as this.

Keep the faith, my friend.

It is nice to know that people like my friend are on the side of the Native Americans.. So many hundreds of providers, without analyzing the situation would begin to prescribe medications to a problem which is strictly SOCIAL..
News about King of Tonga:
King of Tonga


Earlier this year, King George V decided to use his patronage for a major initiative to tackle diabetes in Tonga and other Pacific nations where it has become a serious and debilitating problem.


"Tonga and the Pacific have one of the highest rates of diabetes per capita and my vision is to have a centre of excellence in research and treatment of this totally preventable disease." - His Majesty King George V.


Suffering from Type II diabetes himself, His Majesty is somewhat of an expert on the disease. To mark his recent coronation, he has formed a charity, the Royal Endocrinology Society, to help treat and research diabetes. His Majesty said of the disease, “If not properly managed, it can completely and painfully break the health, and lead to the death of its victims. It hurts their families, already puts a strain on overstretched medical services, and has a negative economic effect.”