Talking Turkey

07/23/2007 08:21 AM |

Last week I had the opportunity to speak to a roundtable of Turkish journalists on how the second largest nation in Europe can help to reinvent and reinvigorate its health care system.

We talked about why getting new drugs to market in a timely manner is in the best interest of the public health. We talked about how government-run health care systemts often make the mistake of focusing on cost-based rather than patient-centric care. We talked about the dangers of counterfeiting. We talked about the need to develop better "evidence" for the era of personalized medicine. We talked about the urgent need to design a health care system that stresses prevention and chronic care.

In short, it sounded very much like the health care debate in Europe and the United States.

Except there's one enormous difference -- Turkey, demographically speaking, is a young nation. And that's a terrific opportunity. Rather than focusing on the health care needs of a fast-aging population (as is the case in the US and the EU), Turkey has the chance to "start young and stay healthy" -- avoiding many of the "chronic" problems we now face (diabetes, hypertension, high cholesterol, obesity, etc.)

Turkey has the chance to avoid these health care anchors and show us all how to do it right.  Read More & Comment...

Mirror, mirror on the wall who's the most conflicted of them all?

07/20/2007 09:58 AM |

Take a look at who is board leader in conflict cash for the upcoming Avandia Adcomm.
Steve Nissen is pocketing nearly $1 million in study money from companies that are directly competing AGAINST Avandia. The rest of the folks have stock and speaking fees less than $10K per. In fact, St. Steven the Pure has racked up more conflict cash than the rest of the exemption seeking members combined..

And the media? Why, nary a word on the conflict back when or now even as Steve spins them feverishly in the lead up to Adcomm.

http://www.fda.gov/ohrms/dockets/ac/07/waivers/2007-4308w1-00-index.htm  Read More & Comment...

A Gathering Against Cancer and For Life

07/18/2007 11:49 AM |

CMPI held an event yesterday (as noted in my previous post) on Capitol Hill where it released a report entitled “The Effect of Chemotherapy
Innovation on Cancer Survival, 1991-2003: State Level Evidence from the SEERMedicare
Linked Database.” The report written by Dr. Frank R. Lichtenberg of Columbia University and the National Bureau of Economic Research in conjunction with the Center for Medicine in the Public Interest proves that using new cancer therapies is an effective way of lengthening the lives of cancer patients.

But it was more than your usual DC get out the report event. It was time to both celebrate what medical progress can provide and reassert the dying proposition that public policy should focus on what value medicines can add to people lives instead of what money can be squeezed from the lives of patients.

Michael Katz, VP of the International Myeloma Foundation http://www.myeloma.org/ spoke of not being a statistic because as a 17 year survivor of multiple myeloma, he should have been dead and not seen his three children grow and graduate college.

Congressman Mike Ferguson spoke of the joy he felt in hearing Michael's story and of the fact that his mom, who also had multiple myeloma, lived long enough to see her grandchildren. He spoke of the pride and joy he felt knowing that Celgene, the company that has developed a pill replacing blood transfusions for MM, is in his district.

Press events are usually canned activities but because of the people and passion that everyone brought, it was much more. I didn't know when we invited Mike that our event fell on the fourth anniversary of his mom's death. But it only reinforced our sense that CMPI's mission is, in Mike's words, to promote medical progress that saves and extends lives.

Thanks to everyone who made this possible.  Read More & Comment...

Alex Hits a Homerun

07/17/2007 07:35 AM |

Berenson, not Rodriguez... With his latest piece describing how reimbursement factors create variations in oncology practice that appear delay access to new and in some individual cases, better, cancer drugs. (He calls them market forces, but why quibble.)

This should be a cautionary tale to those in the comparative effectiveness cult: a reimbursement code is as good as a death sentence to thousands of cancer patients if it creates practice variations that delay access to drugs that work for particular groups of patients.

For even more evidence of that, CMPI released study yesterday by Professor Frank Lichtenberg of Columbia University showing a direct association between access to new cancer drugs and increases in life expectancy and survival from cancer between the years 1991-2003. And for those who bleat that we need comparative effectiveness to turn each patient into a cost center consider that Dr. L found that each additional year of cancer free life cost $4300, a fraction of what other economists pegged the value of that achievement: $250k.

You can find the Lichtenberg study later at http://www.cmpi.org

The Berenson piece is here: http://www.nytimes.com/2007/07/14/health/14lymphoma.html?_r=1&oref=slogin  Read More & Comment...

Media Mangles AHQR Report, But So Do It's Authors

07/16/2007 10:17 PM |

"Older, cheaper diabetes drugs are as safe and effective as newer ones, concludes an analysis that is good news for diabetics and may further hurt sales of Avandia, a blockbuster pill recently tied to heart problems.

The clear winner: metformin, sold as Glucophage and generically for about $100 a year. It works as well as other diabetes pills but does not cause weight gain or too-low blood sugar, the analysis found. It also lowers LDL or bad cholesterol."

http://news.yahoo.com/s/ap/20070716/ap_on_he_me/diabetes_drugs;_ylt=AjRpOmAY4PhCXhkEvojSg37VJRIF

I guess AP was just reading the press release and not the report or even the exec summary which carried these important tidbits:

The study only focused on monotherapy while the trend in diabetes care is towards combination therapy to maintain glycemic control, blood pressure, cholesterol. Hence, Avandia or Actos will be used in combination with Glucphage or insulin, not one or the other.

The study ignored many important clinical endpoints for which combination therapies are used, hyperinsulinaemia, for instance or fat build up.

The study acknowledges that combo therapy works better than monotherapy.

It also acknowledges that the supposed superiority of weight loss associated with metformin could be due to removing a prior drug used in head to head comparision trials so that the weight loss is an artifact of an experiment not the medicine. Oh.

So why did the authors not make these caveats in their statements to the media and so eager to push metformin as the....cheapest and best? Here is what the authors siad in their article in the Annals of Internal Medicine: Drugs like metformin "lower cost, longer use in practice and more intensive scrutiny in long-term trials" But the trend is towards combination therapy. Do I detect a bias, a falling into line with a ideological bent beyond what the data suggest? Is this ALLHAT and CATIE redux?

http://www.annals.org/cgi/content/full/0000605-200709180-00178v1  Read More & Comment...

Arnold Relman: Off His Rocker

07/16/2007 05:34 PM |

To see what happens when too many people toady up to for too long and what being imperious does to one's brain cells and personality, read Arnold Relman's screed against Richard Epstein's book "Overdose: How Excessive Government Regulation Stifles Pharmaceuetical Innovation."

To be fair, Epstein lays into Relman in his book, so Arnie is entitled to hit back. But the review is long, boring and short on detail. He never rebuts Epstein's claim. Rather he just screams that Big Pharma buys and sells the FDA and every other major political institution. Well if that's the case, why do so many of their drugs fail to make past FDA reviewers? If the marketing is so successful why not crank out one me too after another and just ram them down the throats of stupid docs and consumers? Why invest in innovation at all? Then the problem of government regulation disappears.

Relman is so obsessed with his droning that he does not realize he has no point. That is the biomarker of a zealot or some other condition.

http://www.tnr.com/doc.mhtml?i=20070723&s=relman072307  Read More & Comment...

Agency for Health Qualty and Research on Avandia: It's A Wonderful Drug

07/16/2007 05:10 PM |

Avandia raises good cholesterol and (however it raises bad )while controlling diabetes..how about that? To quote the study... "Pioglitazone and rosiglitazone cause a small but significant increase in high-density lipoprotein, often called "good cholesterol" because it promotes the breakdown and removal of cholesterol from the body." This has been Nissen's holy grail...it must kill him to see it reported in a drug he tried to destroy while others he has worked on have tanked...

And the study which looks at all forms a drugs to control Type 2 diabetes, many of which are used in tandem, is a kick in a teeth to Nissen's sloppy and skewed handling of the data and Furberg's hysterical handling of the results thereof. Now that they two have been added to Adcomm, let's see if they behave responsibly before, during and after the meeting instead of trying to inflame passion. My guess is, on the heels of the AHQR study and a recent microvascular study by Eric Topol and colleagues showing a protective effect impact from Avandia in certain patients with metabolic disorders undergoing revascularization, the black box warning will be mild and some primary care docs might even begin to prescribe again, though not to patients at risk for CHF.

Now let's see how the media covers this study and its rebuke to Nissen.

http://www.ahcpr.gov/news/press/pr2007/effdiabpr.htm

Seel also "Peroxisome proliferator-activated receptor gamma agonists for the Prevention of Adverse events following percutaneous coronary Revascularization--results of the PPAR study."

Am Heart J. 2007 Jul;154(1):137-43.  Read More & Comment...

See, It WAS Big Pharma All Along....

07/13/2007 10:08 AM |

When is a serious side effect not a serious side effect?
When the people who are at risk or talk about it receive support from drug companies.
At least that's what the WSJ implies in it's article about people with epilepsy who suffer seizures when they are switched -- without their consent -- to a generic version of an anti-convulsant to save a few bucks.

PILL PUSH
Industry Fights Switch
To Generics for Epilepsy
Big Drug Makers Help
Patient Groups Lobby;
More Attention to States
By SARAH RUBENSTEIN

In state legislatures across the country, the Epilepsy Foundation has been campaigning for bills that would make it harder for pharmacists to switch patients to inexpensive generic epilepsy pills. The effort is getting behind-the-scenes support from drug companies -- a sign of how the industry, long a potent lobbying force in Washington, is increasingly looking to states to achieve its goals.

http://online.wsj.com/article/SB118426152232264867-search.html?KEYWORDS=epilepsy&COLLECTION=wsjie/6month

I will get to the science behind this issue -- and there is science, though you wouldn't know it from reading the piece -- in a second. But consider this:

The WSJ piece depicts the epilepsy drug switch-side effect issue as anecdot dotted campaign led by Big Pharma to keep their drugs on formulary. Yet Steve Nissen receives money from drug companies and did a slap dash study about heart attack risk of Avandia and that was front page news. He had to pool studies of widely varying quality and size (basically pooling anecdotal information) and he was hailed by the media as a whistleblower.

Now AP reports that the FDA is getting anecdotal reports of heart attacks from Avandia users (no surprise since diabetics are 2x likely to have heart problems than others) and claims that this is evidence of Avandia's dangers previously being under-reported. "Only five heart attacks were reported in the 35 days before the study, compared with 90 in the same period afterward. Heart-related hospitalizations went from 11 to 126. The reports involve rosiglitazone, sold as Avandia and Avandamet."


http://news.yahoo.com/s/ap/20070713/ap_on_he_me/diabetes_drug_risks_8

Now to the evidence of drug switching triggering seizures. Anti-convulsants have very narrow therapeutic windows. So switching, whether from one brand to another or from a brand to a cheaper older med can cause problems. That is fact.

Here is one study "Compulsory generic switching of antiepileptic drugs: high switchback rates to branded compounds compared with other drug classes." Epilepsia. 2007 Mar;48(3):464-9. The study found: These results reflect poor acceptance of switching AEDs (anti-epileptic drugs) to generic compounds. They may also indicate increased toxicity and/or loss of seizure control associated with generic AED use."

So what did we learn class?

Take adverse reports after hysterical reporting of a sloppy and politically motivated meta analysis on Avandia seriously. Why? Not generated by Big Pharma.

Ignore the reports of seizures associated with compulsory drug switching to generic anti convulsants. Why? Obviously generated by Big Pharma.

And what about the scientific basis behind the seizures? Too bad. If someone is supported by Big Pharma, then they obviously deserve to get seizures anyway.  Read More & Comment...

Sicko Sinks At the Box Office

07/12/2007 04:22 PM |

Sicko open last week in 300 theaters and took in $4.5 mill. This past week it took in $3.6 in over 700 theaters.

More people saw Moore get the crap kicked out of him by Sanjay Gupta on Larry King Live than went to see his movie.  Read More & Comment...

Want To Live Longer? Take New Drugs

07/12/2007 08:27 AM |

In another blow to those who want keep Americans taking old medicines by banning access to free samples, marketing, continuing medical education, off label use and other methods that increase new drug use, this from my former perch at the Manhattan Institute and Frank Lichtenberg:

"It is no surprise that Americans are living longer today than in previous generations. A typical baby born in 1900 was expected to live to about age 45. Today, life expectancy at birth is about 78. Less well known, however, is the fact that the gains in life expectancy have not been uniform across the country. In his new study—the first of its kind—Columbia University researcher Frank Lichtenberg set out to find out which states are the leaders, which ones are the laggards, and why.

Lichtenberg then set out to examine why this “longevity increase gap” exists by measuring the impact of several factors that researchers agree could affect life expectancy. He found that, although some obvious suspects—obesity, smoking, and the incidence of HIV/AIDS—played a role, the most important factor was “medical innovation.”

Specifically, Lichtenberg found that longevity increased the most in those states where access to newer drugs—measured by mean “vintage” (FDA approval year)—in Medicaid and Medicare programs has increased the most. In fact, about two-thirds of the potential increase in longevity—the longevity increase that would have occurred if obesity, income, and other factors had not changed—is attributable to the use of newer drugs. "

Here's a link to the study:http://www.manhattan-institute.org/html/mpr_04.htm  Read More & Comment...

CNN's Dr. Gupta Gives Michael Moore an Evidence-Based Enema

07/11/2007 07:52 PM |

By the looks of it and the typical Moore reaction (attacking his critics personally) CNN's Sanjay Gupta's look at the fudgy facts of Moore's movie have really hit a nerve. Moore was really steaming as Gupta continued to point out that links to MSNBC web sites are not real citations and projected numbers are not actual dollars spent.

Even when Moore's acolytes and staffers try to defend him they step in it. For example, Deborah Burger, the head of the California Nurses Association claims that Aetna CEO Troy Brennan claimed that " recent statistics from the Institution of Healthcare Improvement document "that people are waiting an average of about 70 days to see a provider."

http://www.michaelmoore.com/sicko/news/article.php?id=10023

Uh, actually the Institution FOR Healthcare Improvement document was referring to the Amarillo VA Health Care System which reorganized Primary Care in January 2000 based on the principles of Advanced Clinic Access. It had a waiting time for 76 days and reduced the time to 20 days by using the new software system. And the system is designed to reduce the backlog of no-show appointments which is unrelated to excess demand.

It took them one month to cut the waiting time by two thirds. Meanwhile, primary care waiting time for first appointments in the UK are, what, 3 months at a minimum?

And don't give me the crap from the Commonwealth Fund...that compared Medicaid recipients (government care) and the unisured poor to middle class and rich people who supplement their care with private health insurance in other countries. And Commonwealth failed to sample in rural areas internationally where health and access disparities show up. And even then, Americans did as well or better than less diverse and urbanized countries in getting prompt care. Oh, they never told you that? Neither does Michael Moore.

Read here
  Read More & Comment...

The Lead Law Firm of the Prescription Action Litigation Project Goes To the Slammer

07/11/2007 08:26 AM |

The Priesthood of Pharmaceutical Purists use trial attorney winnings to in part finance their attack on industry. One of their meal tickets is going to three squares behind bars.....

"Milberg Weiss' Bershad Pleads Guilty to Conspiracy in Kickback Plan
Name partner at securities plaintiffs law firm agrees to cooperate and to forfeit $7.75 million"

David J. Bershad, a name partner at securities plaintiffs law firm Milberg Weiss & Bershad, has pleaded guilty to federal charges that he conspired in the payment of illegal kickbacks to individual class action plaintiffs.

The guilty plea by Bershad, entered Monday afternoon in federal court in Los Angeles, raises the stakes for his co-defendants, former fellow name partner Steven G. Schulman and the Milberg Weiss firm itself, as well as the other major Milberg Weiss figures, Melvyn I. Weiss and William S. Lerach, who have so far escaped indictment.

http://www.law.com/jsp/article.jsp?id=1183971987057&rss=newswire

Now Millberg Weiss is part of the Prescription Access Litigation Project (PAL). But PAL conveniently leaves the firm off it's website. But since drugwonks is all about transparency, here is a reminder of their close connection, courtesy of MassPIRG

http://masspirg.org/MA.asp?id2=5318&id3=MA& and PAL itself

http://www.prescriptionaccess.org/press/pressreleases?id=0013  Read More & Comment...

Steve Nissen and the Media Inconsistent Together

07/11/2007 08:19 AM |

Trevor Butterworth sums up the sad state of Steve Nissen, the NEJM and the media in his post. And the Priesthood of Pharmaceutical Purists, trial attorneys and assorted Whack Packers want to entrust the public health to these sort of people???

http://www.huffingtonpost.com/trevor-butterworth/a-crusading-doctor-stumbl_b_55681.html  Read More & Comment...

Wide Awake

07/10/2007 11:24 AM |

I wanted to call attention to my recent piece in the Florida Sun-Sentinel about insomnia, and its related health issues. The piece centers on the recent excellent Alan Berliner documentary Wide Awake on HBO.
I am what i would call a self-induced insomniac, i use it to get my writing done and meet deadlines. Unfortunately, this establishes a pattern of middle of the night wakefulness which persists even when i have no deadline. This is not good for my health. I don't currently take sleeping pills, but many of my patients find them useful - and in fact Ambien is one of those examples of good drugs that to from panacea to panic whenevever a media report focuses on the rare sleepwalker. All drugs should be managed or monitored by the doctors who prescribe them, but they are not good guys or bad guys, they are useful arrows in our medical quiver.

http://www.sun-sentinel.com/news/opinion/sfl-forum06insomnianbjul06,0,5107682.story?coll=sfla-news-opinion  Read More & Comment...

The Whack Pack's Attack on Medical Progress

07/09/2007 10:13 PM |

The Journal of Life Science provides a great weekly brief of health care and medical innovation news and opinion. This week is no different.

http://www.tjols.com/wb/07jul06.html#diabetes

What I find striking is that so many of the incremental advances in medicine -- those that will lead to more predictive and preventive care -- will depend on future investment to both test the validity and reliability of new information as real products. To quote Robert Solow many if not most innovations need to be embodied in new kinds of ..... equipment before they can be made effective. Improvements in technology affect output only to the extent that they are carried into practice either by net capital formation or by the replacement of old-fashioned equipment by the latest models…”

Of course, that process of commercialization requires profit, risk taking, marketing, industrial-academic relationships, patent protection. In short, everything need to make this world a better place through technological advancement most of what I will call the Whack Pack either opposes, makes money critcizing or suing.

Now nothing's perfect and change is constant. Compassion, trust and honesty should inform all social relations. But to suggest ridding science of commercialism will bring about a better and brave new world is...in a word, whacky and dangerous.  Read More & Comment...

"Where are all the dead Canadians?"

07/09/2007 09:55 AM |

That oft repeated question by the proponents of drug importation. Sadly, today's answer is, in Vancouver.

Here's the news from Canada's newspaper of record, the Toronto Globe & Mail.

ONLINE PHARMACIES

Counterfeit drugs caused woman's death, coroner concludes
ARMINA LIGAYA

July 6, 2007

VANCOUVER -- Shoddy pills from a bogus online pharmacy are to blame for the death of a 58-year-old woman from Vancouver Island, a coroner's report says.

Yesterday's conclusion makes Marcia Bergeron the first clear-cut case of a death stemming from counterfeit drugs bought on the Internet, but it likely won't be the last, said Rose Stanton, regional coroner for Vancouver Island.

"The quantity of seized counterfeit medication is huge," she said. "And so, what we have is the first person [for whom] we have all the facts, who we know died as a result of these drugs.

"But what we also know is lots of people are buying these drugs. So the potential for more deaths is high."

Ms. Bergeron was found by a friend on Dec. 28, 2006, in her bed in a normal sleeping position. Emergency services were called, but it was clear she had been dead for some time.

Three types of pills were found at Ms. Bergeron's home. One contained Zolpidem, a powerful hypnotic not available in Canada. Another contained the anti-anxiety medication Alprazolam, which is available with a prescription, and the third contained acetaminophen.

These drugs were later determined to be laced with extremely high quantities of metal. The acetaminophen pill had 15 times the amount of aluminum that would be fatal, Ms. Stanton said.

An autopsy showed that Ms. Bergeron died of cardiac arrhythmia stemming from metal toxicity.

In the weeks and months leading up to her death, she complained of flu-like symptoms. Ms. Bergeron said, in e-mails to a friend, that her hair was falling out, and she suffered from nausea, diarrhea, aching joints and blurry vision.

When the pills were tested, they were of such poor quality, the ingredients seemed "mashed together" Ms. Stanton said. The mixture of drugs and metal in each pill would vary depending on which portion was examined, she said.

The metal contaminants were likely part of the filler materials used to make the pills, the coroner's report said.

On Ms. Bergeron's computer, records showed she had been visiting websites from which medication could be purchased.

When U.S. Food and Drug Administration investigators examined her hard drive, it showed Ms. Bergeron bought Zolpidem - a powerful sedative available by prescription in the U.S. but not in Canada.

The website she used, which purported to be Canadian but has since gone offline, was previously flagged by the FDA concerning counterfeit Zolpidem.

Because of all these elements - computer records, e-mails, drugs found on scene and a subsequent autopsy - investigators were able to definitively link the online drugs to Ms. Bergeron's death.

It's an FDA first, Ms. Stanton said.

She said the website Ms. Bergeron used is one of thousands that claim to be reputable pharmacies.

"The site that she purchased from is one of a group of sites that the FDA says use the tactic of phoning people after they get the first order," she said. "They phone for the renewal so there isn't a computer record."

Marnie Mitchell, CEO of the B.C. Pharmacy Association said that Canada has a very regulated and monitored pharmacy system, and stepping away from it has risks.

"Online sources are very difficult to assess their legitimacy and their safety," she said. "This is a very tragic episode and illustration of the problems that stem from going to those kinds of places."

Cracking down on these websites, however, would be a difficult endeavour, she said, because they change and shift very quickly and are hard to trace.

Instead, she recommended the federal government launch a public-awareness campaign to warn people of the potential dangers.

Alain Desroches, spokesperson for Health Canada said the agency regularly flags counterfeit products and issues public advisories. It also works with RCMP in investigating counterfeit drugs. However, he could not comment on any policy changes that would stem from the coroner's findings.

"We welcome the report and it's going to be reviewed carefully," he said.  Read More & Comment...

MaLADE-O

07/09/2007 09:23 AM |

In today's New York Times, Paul Krugman calls for universal health care in the United States, calls those who oppose it all sorts of nasty names, and points to SiCKO as his proof of concept.

Note to Paul: Read the ads for SiCKO in your own paper -- it's billed as a comedy.

To get a feel for his general position, consider this statement, "Medicare ... is being undermined by privatization."

What he doesn't say is that ... it's working. Every poll shows that seniors are very pleased with the Part D benefit-- and by huge margins. And every government report shows that the program is coming in significantly below cost projections.

Imagine that, a government program that people like and comes in under budget. Privatization may seem like a frightening concept to Mr. Krugman, but it sure works.

But why let facts get in the way when you've got an agenda to pursue?

And here's the agenda, summed up in one sentence:

"Universal health care would save thousands of American lives each year, while actually saving money."

Really? All the statistics from Europe and other nations with government-run health care say different. Having just returned from a conference of European health care experts, regulatory officials, and legislators, I can attest to the many problems European government are facing as they try to reinvent their own national systems for the 21st Century.

Paul -- come with me to Europe and let's film a documentary of not only care denied but care unavailable. I'm sure we could make it as "entertaining" as SiCKO. It's easy to prove an argument when you cherry-pick the facts. We can call our movie "MaLADE-O."

Ooh-la-la!

Mark Twain wrote, "For every complex problem there is a simple solution -- and it is usually wrong."

Alas, there is no perfect, easy solution to the American health care miasma. That only happens in the movies.

For a more balanced view of how to advance the cause of health care in America, read what HHS Secretary Mike Leavitt has to say ...

http://www.washingtontimes.com/article/20070709/EDITORIAL/107090020/1013

And -- see you at the movies.  Read More & Comment...

Fear of Flossing

07/09/2007 07:42 AM |

Word on the Hill is that Rahm Emanuel is going to try to tag sound FDA reform legislation with an unsound amendment on -- yes, you guessed it -- drug importation. Is anyone out there shocked? Probably not. After all, for Mr. Emanuel politics is more important than the public health.

Here's a new Chicago Tribune op-ed on why drug importation is a bad idea:

http://www.chicagotribune.com/news/opinion/chi-oped0708taintjul08,0,1697228.story?coll=chi-newsopinioncommentary-hed

You can't be for drug safety one day and against it the next. You can't rant against counterfeit tainted toothpaste and embrace the importation of foreign drugs. It's intellectually dishonest and contrary to the best interests of the public health.  Read More & Comment...

my July Antidote column in M,M, &M on avandia

07/08/2007 02:16 PM |

When Rezulin was removed from the market several years ago, the top endocrinologist I worked with was quite upset. Of course he knew about the few cases of severe liver failure and the rare death, but he also knew how many patients benefited directly from the drug. "Avandia will be next," he predicted.
Thiazolidinediones (TZDs) are a class of drugs which improve insulin receptor sensitivity and reverse the insulin resistance typically seen in type 2 diabetes. Since most type 2 diabetics have too few receptors per body surface area, the TZDs are very useful drugs.
The fact that patients ont he remaining two TZDs (Avandia and Actos) can gain weight on these drugs is not news. The question of whether they can cause or worsen heart failure has long been discussed. Unfortunately the current raging debate and targeting of the FDA and the drug manufacturers doesn't directly address this question. The existing information is based on mathematical analyses of previously published data and is weak.
Prospective randomized trials are necessary, but what should a clinician do? All too often, as the pendulum swings from panacea to panic, a perfectly good medication has its reputation damaged or destroyed based on limited or overblown results, all in the name of drug safety.
To give just one example as it relates to TZDs, it is clear that controlling blood sugar is important in preventing diabetic end organ damage. Among these crucial organs we try to protect is the heart. Everyone agrees that Avandia and Actos help to significantly lower blood sugar. But as their reputations are damaged in the media, how many safety-driven zealots have stopped to consider what uncontrolled sugars mean to the heart? Now that patients - and doctors - will be running from these drugs with their new "black box" warnings, what will be the clinical results? In other words, which will cause more heart damage; the drugs themselves, or stopping them?  Read More & Comment...

An Inconvenient Truth: Kids and Counterfeit Meds

07/06/2007 10:57 AM |

If you think it's easy for Al Gore III to score Vicodin and Aderall without a prescription, ask Zach Goldberg (aka his dad) just how quick and convenient it is to buy roids, Vicodin, ritalin, etc. online using his age (19) or any age for that matter. I did it, no problem using two different credit cards.

http://news.yahoo.com/s/ap/20070706/ap_on_he_me/gore_s_son_drugs;_ylt=AjKNKTx3L_N9zjupcFNwSgER.3QA

Note to Rahm Emanuel: Most fake drugs will come through the Web. They will be bought by kids who will use them recreationally or to resell them. Organized crime will profit and kids will suffer.

At what point will your concern for the welfare of kids overtake your politically motivated hatred of drug companies?  Read More & Comment...