WDDTY e-News Broadcast - 17 May 2007

[Guest guest]

Boy, this one is LOADED . . .

 

e-news(WDDTY e-News)

 

  E-news broadcast  17 May 2007    No.360

 

NEWS BROUGHT TO YOU BY 

WHAT DOCTORS DON?T TELL YOU

  

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News content

 

STENTS:  25 years on and specialists learn that lifestyle changes are

just as effective

DOCTOR ERRORS:  Even the patient can?t spot them

DRUG SAFETY:  It?s not just chemotherapy that causes blood disorder

ASPIRIN:  It doesn?t stop cognitive decline after all

?OFF-LABEL?:  Doctors play fast and loose with drugs, and the patient

suffers

ANTIPSYCHOTICS FOR CHILDREN:  Psychiatrists who are paid the most

prescribe the most

 

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STENTS:  25 years on and specialists learn that lifestyle changes are

just as effective

 

The stent has become part of the standard toolkit for the heart

specialist.  It?s a crude, but effective, device for ?propping up?

arteries that may collapse after angioplasty, or which may get blocked

by a build-up of plaque in a process known as restenosis.

This micro-engineering has been actively used for the past 25 years ?

and it?s only now just occurred to specialists that simple, and

inexpensive, lifestyle changes work just as well.

A new trial, involving 2,297 heart patients with at least one blocked

coronary artery, found that they fared just as well if they stopped

smoking, exercised, and improved their diet.

They lived as long, if not longer, than the patients who were given a

stent, but who otherwise carried on as before, and their quality of life

was also far higher.

This is bad news for American heart specialists who routinely insert 1

million stents a year, funded by health insurance plans. 

The new study, known as Courage (Clinical Outcomes Utilizing

Revascularization and Aggressive Drug Evaluation), may put an end to the

?irrational exuberance that surrounds stenting?, says Steven Nissen,

immediate past president of the American College of Cardiology.

But don?t bank on it.  As another specialist said: ?Once Courage was

released, I asked myself how this would change my practice, and I

realized it wouldn?t.?

Carry on stenting.

(Source:  Journal of the American Medical Association, 2007; 297:

1967-8).

 

 

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DOCTOR ERRORS:  Even the patient can?t spot them

 

Doctors have become so hopeless at spotting ? and reporting ? their own

errors that they are asking their victims, the patients, to do it for

them.

Unfortunately, a new report suggests that the patient is just as bad as

the doctor ? although the whole dubious system does presuppose that the

victim knows when an error has happened.  And as 100,000 Americans die

each year from medical error it also assumes that their survivors know

about the error.

As it is, the patient ? or his surviving family ? often gets it wrong

when identifying an error, according to a study from Harvard

University.  After monitoring an oncology unit between February and

September 2004, the researchers found that the patient was mistaking

poor service for medical error.

Can?t rely on anyone these days.

(Source:  Journal on Quality and Patient Safety, 2007; 33: 83-9).

 

 

 

DRUG SAFETY:  It?s not just chemotherapy that causes blood disorder

 

Agranulocytosis is a serious condition where the body produces

insufficient white blood cells, making the sufferer much more prone to

infection.

It?s a common side effect of chemotherapy drugs ? but they are far from

being the only culprits.  In a new study, researchers have pinpointed

125 other drugs that can also cause agranulocytosis.

They found 980 cases of agranulocytosis caused by drugs other than

chemotherapy since 1966, including carbimazole, clozapine, dapsone,

dipyrone, methimazole, penicillin, and rituzimab, a group that was

responsible for more than half of all cases.

Of the cases reported, six per cent ? or 58 ? were fatal.

None of this is particularly new.  Doctors have known ? or should have

known ? for quite some time that many anti-epilepsy, anti-thyroid,

antibiotics, antipsychotics, and the NSAIDs can cause

agranulocytosis. 

Doesn?t hurt reminding them, we suppose.

(Source:  Annals of Internal Medicine, 2007; 146: 657-65).

 

 

 

ASPIRIN:  It doesn?t stop cognitive decline after all

 

Aspirin has become the great just-in-case treatment for the West.  A

little a day is supposed to ward off heart disease, high cholesterol,

and mental decline.  Actually, strike off that last one.

A study that monitored 6,377 healthy women aged 65 or older, who took

100 mg aspirin every other day for nine years, found that they didn?t

fare any better than women who were taking a sugar pill, or placebo.

There was virtually no difference between the two groups in terms of

cognition and verbal memory ? and each group had the same numbers who

suffered substantial decline in their mental abilities.  In other

words, aspirin didn?t have any protective effect.

(Source: British Medical Journal, 2007; 334: 987-90).

 

 

 

?OFF-LABEL?:  Doctors play fast and loose with drugs, and the patient

suffers

 

As if drugs weren?t dangerous enough already, doctors often use them as

?off-label? therapies as well.  It?s a medical euphemism for playing

around with drugs in ways for which they?ve not been approved or tested

for their safety.

?Off-label? prescribing is rampant, as researchers have discovered. 

In one study of 7,752 heart patients, they found that drug-eluting

stents ? metal tubes that release a drug to help stop restenosis, where

artery walls become blocked by plaque ? were wrongly used in 47 per cent

of all cases.

Worse, this inappropriate use endangered the lives of the patients, who

were more than twice as likely to die or suffer a serious heart attack

than someone whose stent was used properly.

The patient whose stent was used inappropriately faced this level of

risk for up to a year following the procedure.

(Source: Journal of the American Medical Association, 2007; 297:

1992-2000).

 

 

 

ANTIPSYCHOTICS FOR CHILDREN:  Psychiatrists who are paid the most

prescribe the most

 

Why are so many young children given a powerful antipsychotic? 

Because the psychiatrist is paid handsomely to write out the

prescription.

Psychiatrists in America who are paid upwards of $5,000 from

manufacturers of atypical antipsychotics on average write three times as

many prescriptions for the drugs as those who don?t get such a good

pay-off.

Between 2000 and 2005, antipsychotic use among American children

increased nine-fold, while each psychiatrist received an average payment

of $1,750 from a drug manufacturer during the same period.

The alarming practice of prescription pay-off has come to light only

because just one state in the USA ? Minnesota ? requires full disclosure

of industry payments to physicians. 

As one psychiatrist put it: ?There?s an irony that psychiatrists ask

patients to have insights into themselves, but we don?t connect the

wires in our own lives about how money is affecting our profession and

putting our patients at risk.?

Silly them.

(Source:  New York Times, 10 May, 2007).

 

 

 

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