Grand Rounds Volume 3 Number 1 Happy Anniversary

Grand Rounds 3.1 Happy Anniversary


Welcome to the second anniversary of the weekly roundup of the best blog writing among health and medical writers. We’ve come a long way since Nick Genes started this weekly review as a forum of physicians writing for each other, and now have a more active participation from an incredibly diverse number of voices. Nick was kind enough to interview me for Medscape’s weekly introduction of the hosts, and I’m amazed that he has the time and energy to keep this up while in residency.

As this is an anniversary, I wanted to host a party here at Tech Medicine, and invite you to partake in the delicious treats you find at different celebrations we all love. In a few instances I’ve made the treats more del.icio.us by linking to a couple writers that talk up the same topic to give a fuller richness to the conversations‘ multiple points of view. The more we writers refer to each other’s posts and the original article we’re talking about, the more that others can find our conversations when they search on that topic. Come join the party and add to the buzz!

Here’s an overview of the party and feel free to click thru to that section (lots of entries this week!):

Party preparation:
Guest list: all are invited, even if some haven‘t come.
Appetizers: what’s a party without great food? Plenty of food & nutrition bloggers think so.
Entertainers: enthusiastic goofballs sharing and inspiring wonder

Party Proceedings:
Get the party started: the party comes to life when these folks show up
Conversation starters: hot topics among medbloggers this week
Rememberances: parties bring anniversaries to mind, and there’s nothing like giving honor to the good old days
Who’s hot and bothered and rallying for a cause: give these folks wide berth! They feel strongly about stuff and aren’t afraid to tell ya.

After the party:
Whoa... what a night! Here's what hits you in the morning.
Party gadflies: the buzz continues with the paparazzi
Continuing the party, in person: what good is a party without a reunion, in real life!


Guest list:

As Grand Rounds has had a policy of welcoming all who have an interest in sharing about their experience, all health carnivals and blog networks are invited to join in, even if they don‘t usually come, except for those in medlogs.
Health & Medical Carnivals such as Pediatric Grand Rounds and Nursing: Change of shift, or these networks of health bloggers:
Healthline
The Medical Blog Network
WebMD
Yahoo
Medscape MedStudents
Medscape Nurses
Med Student Blogring



Appetizers:

You know, for me, a party’s only as good as the folks that get together. Of course since you all are exactly my cup of tea, the other thing that makes a party for me is the grub (and the wine but that‘s a for a different carnival):

Spinach and E. Coli tops Digg Health currently, but the articles there link to the same old, same old MSM press, rather than original opinions (del.icio.us):
The CDC's the most current, whereas NYT and CNN can't keep up.
Dr. Paul Auerbach of Healthline‘s Outdoor Health encourages us to avoid “Spinach Woes” by boiling thoroughly and washing dishes as well. I've always wondered how pre-washed veggies keep fresh. Always on point, Medpundit keeps up with the developments. Dr. Charles gives the lowdown on the culprit, E. Coli. Machine harvesting may have a lot to do with the contamination. Img courtesy of KidneyNotes.

Everyone worries about the cholesterol in our vittles and Healthline’s Health Observances pumps up National Educational Cholesterol Month as I at Tech Medicine cover a recent NEJM article about how a specific branded drug possibly helps more than the benefit from the absolute amount of cholesterol lowering.

Cynthia Sass of Healthline‘s Diet Dish in "Eating Your Feelings" discusses the food/feelings connection, how emotional eating is practically learned at birth, along with strategies you can use to help defray emotional eating.

Enjoy too many of these vittles and you may be concerned about diabetes and Amy Tenderich’s critical of but intrigued with the possibility of preventing Type 2 Diabetes suggested by the Avandia DREAM study (sponsored by manufacturer GlaxoSmithKline). Kelly Close provided her the dirt. And many are commenting on this since the NYTimes covered the story.

My friends know that I’m a total wine nut, but this ad for non-alcoholic beer strikes me as SOOO wrong

And speaking of dietary vices, if you saw me this past week at Epic’s User Group Meeting in Madison, you’d know I lived off of the “Worst Seven Foods for Health and Longevity” rather than the purported best (even though I agree they‘re delicious)

There’s Free Pizza with Vaginal Exam Practice for Vitum Medicinus, a first-year medical student, who thinks that being in medical school might take a bit of getting used to, and passes on this extracurricular activity.



Entertainers:

What’s a party without great entertainment? Here’s our lineup:

Wow, there’s a crowd around Dr. Wes as he shares his favorite parlor trick -- no need for hired magicians!

Who’s that wide-eyed guy gesticulating wildly in the corner? I overheard he’s sharing the wonder of seeing for the first time how to briefly kill someone and bring them back with adenosine.

Quick, guess the heart murmur: "thump, swoosh, thump" or "Bang Bang Bang" or "Ka boom!" heard by William Rubin’s student

Why are those musicians averting their gaze when focused deeply into their performance? Dr. Emer say’s it’s about “HOW TO THINK BETTER” - 'looking away' has its rewards (I know this is tru for me when I argue with my wife...)

What’s a party without some game going on the tube? Bard-Parker loves his football, but reflected on the danger as the Buccaneers quarterback had his spleen emergently removed after getting sacked a few times. GruntDoc fleshes this out with pictures & video of how the Bucc Qb got fixed.

A party’s not a party without some tunes, and for our listening pleasure, KidneyNotes has a list of the newsy & medical podcasts he listens to on his iPod on the way to work.



Let’s Get this party started:

Amy Tenderich breaks the start-of-party nervous quiet with a cry of consternation plus expletive yelling there’s “Trouble in Reimbursement City” when third-party payers won't be covering continuous glucose monitoring any time soon.

Fellow acute care doc Shadowfax similarly cries out about a near-explosive experience in his ER, when a woman came “packing,” not just concealing drugs "on her person" which was the initial concern. This image caused a lot of consternation across the medblogosphere.

I fully support a physician’s choice to practice according to their conscience, and am sympathetic to this particular point of view, but I still felt badly for this gal’s experience unsuccessfully finding emergency contraception.

Another unsuccessful attempt: what happens when the patient's body doesn't cooperate: what's more uncomfortable, when a practitioner begins to lose confidence in his/her skills, or when a patient does?

Every medblogger was saddened by the loss of Steve Irwin (he did have 300 million tune in to his funeral), and my buddy Ves shows why he was so unlucky, with examples of the 2 lucky enough to survive such an injury, and follow-on commentary on the injury from my ER pal Paul.



Conversation starters:

Medical providers who are reading recognize this as a frequent question at a party, “hey doc, can you look at this rash?” Well, Dr. Paul Auerbach of Healthline‘s Outdoor Health reveals how he recently responded to a pal’s similar request in “A Diagnostic Dilemma”

When my friends get together for a party the hottest topic is always our kids, and Andrea Giancoli of Healthline’s From the Family Fork chats about improving preschoolers’ health in “Preschoolers Get a "Healthy Start"“ from Dr. Christine L. Williams’ Health Start program that was tested and started in upstate New York.

If it’s not about our kids, it’s about getting pregnant, and a bunch of obstetricians are chatting in the corner:
Dr. Carl Herbert of Healthline’s The ART of Conception covers the ethics of infertility treatments when reviewing the U.S. President's Council on Bioethics report.
Dr. Ken Troffater of Healthline’s Fruit of the Womb shares “A Stitch in Time” which describes his experience assisting a pregnant patient with twins and early dilation of her cervix at 22 weeks, requiring emergency “cerclage” which helped the patient immensely.

Electronic medical records is a frequent topic among medbloggers, and all the more so this week with a NYT op-ed by recently dearly departed U.S. chief of Health IT, David Brailer who supports portability of records by funding the programming of connections between different institutions.
John Sharp of eHealth cries 'hear, hear' (pro)

An earlier NYT article supporting EMR keeps getting press among medbloggers who are all pro-EMR: 1, 2, 3, 4, 5, 6, 7 points of view.

Bill Crounse usually blogs on EMR but this week brings up how mini-clinics in retail locations like Wal-mart can improve patient convenience, but my question is does it improve the quality of care without sending records to the primary care provider, and being able to look up records from the PCP?



Rememberances:

Some of the stories told at the party are really memorable, some stories from the trenches while they’re currently slogging thru it, and some stories from the vivid past to enlighten us of what’s occurred.

The way some remember is by continuing to help out, providing mobile medical care by RV, one year after the flooding of Katrina and Rita: Dr. Cheri LeBlanc. She was the key physician helping us work with Pastor's Resource Council Compassion when I went to NOLA to provide Katrina relief last fall. Others recall the Katrina crisis at Charity Hospital.

Dr. Charles beautifully remembers a patient whom he had the privilege of being the last to care for and reflects on others who touched her.

Stories of the old days in his community hospital as a surgeon railing against the machine, parts 1, 2, 3, 4.

Continuing on the surgical meme, Barb of Barbados Butterfly has posted a series of stories about her hard times during her first term as a surgical registrar in Australia. In 'Darker Days' Barb describes her fears, tears and self-doubts in the midst of bloody death, medico-legal dramas, heavy drinking, industrial disputes, M&M (Morbidity and Mortality) conferences and fatigue-driven naps on the side of
the highway. Parts 1, 2,

Many are recalling 9/11:
From Healthline's Cancer Treatment and Survivorship by Dr. Cyndy King, there's a connection between 9/11 survivors and cancer patients: survivorship.

Honoring our heroes is one way to manage with what terrible news we have to communicate, and Jarrad honors his oncology mentors beautifully.

Relating our own war stories is another way to honor the past, and Tinquebelle returns to blogging after a many year hiatus, relating the personal risks of and stress during delivering HIV-infected drug addled mothers and her empathy for them.



Who’s hot and bothered and rallying for a cause:

Other than the entertainers and yarn-weavers at a party, you have some who passionately pump up pressing punditry - these folks evangelize their point of view.

With all of the usual Pro-National Health Insurance blogging from Matthew Holt's THCB and Graham Walker it was interesting to hear from someone who is Anti-Single payer because of the increased wait times.

Decreasing Medicare reimbursement is leading MDs to drop Medicare from their practice, do cosmetic procedures, or leave medicine altogether, Bob Vineyard reports.

Neonatal Doc rallies a anti-eugenics cry against the abortion of disabled embryos.

The most compelling writing among blogs is the stories revealing what goes on behind the scenes. This post about the GHF concerns frustrations about patients who are frequent visitors to the ER, and how to deal with them for good (I’m specifically disgusted with this activity, as I‘ve seen it happen mostly from other hospitals in big cities “transferring“ patients to the city my residency program was in.)

One way ERs don't want to deal with them for good is this way: dying in their waiting rooms noted by A Hearty Life. (del.icio.us) Many were equally up in arms about this terrible outcome, as the Death in the Illinois ER Ruled a Homicide: in Waukegan, 49-year-old Beatrice Vance died of MI waiting in ER: Notes from Dr. RW, Medpundit, GruntDoc, Kevin, M.D., Medical Connectivity Consulting, Kevin, M.D., NHS Blog Doctor, and ProfessorBainbridge.

There’s nothing like talking money to egg on docs, and radiologists avoid malpractice litigation by not reviewing mammograms since there’s been a 50% increase in cost of average indemnification for all breast cancer malpractice litigation of $438,000 in 2002 from 1995.

Amy Tenderich’s concerned that there’s tons more workers in “Healthcare is Hot” but patients aren’t getting better care.

Susan Palwick, a volunteer ER chaplain has strong views on helping suicidal patients.

Matthew Holt calls attention to the fact that someone’s gotta be making it hand over fist with the rising costs since that represents income to someone. Elisa Camahort chimes in about healthcare company profits in the last couple of years rising with flat revenues. When's the congressional hearing?

Rallying about $4 Wal-mart generic prescriptions:
Con: If Wal-Mart's list becomes everybody's list, that means Wal-Mart is setting national health care policy. Put another way, someone at Wal-Mart will be deciding if your blood pressure will be treated with atenolol or metoprolol. Or if, after a root canal, your dentist will send you home with Lortab or Darvocet. In that light, it may matter just a little.
Pro: Fard sees this simply as brand-building but possibly challenging the PBMs if successful.

Dr. Anonymous considers the FDA a bureaucracy without merit and next week's Grand Rounds host thinks clinical trials are sometimes without merit as well.

Some shoutin' goin' on in the corner supporting rehabilitation of sex offenders.

And a whisper in another corner about possible asymptomatic bird flu, which I have not read anything about and would doubt based on the severity of illness of those affected to this date.

Local medblogger Kim notes that nurses who provide all of the care and don't delegate are better nurses for it -- they know what's going on with their patients.



After the party:

Have you ever woke up the morning after and felt a tinsy bit of regret? Here are some folks who’ve shared that regret, and others find a way to redemption.

Fat doctor, whose I’ve loved for her personal accounts of treament for stroke, struck out last night, stone drunk, then hung over. Nice to know medbloggers are human, and thank goodness for anonymity (i hope it stays that way).

A little sore when you got up? Dr. Jolie Bookspan, Healthline’s Fitness Fixer discusses “Fixing the Commonest Source of Mystery Lower Back Pain”

Here's a step-by-step path back to Babe-dom full health.

Regrets about missing hints by the signs of patients although they refuse to share symptoms.

Regrets about through medical training having “had the experience but missed the meaning… [professors] who trained me would fit better with ‘had too much experience but deliberately (dis)miss the meaning‘”

If you follow that cup of hangover-chasing coffee with 4 more, you could possibly reduce your risk for Alzheimer’s (if you were a rat that is).

There’s nothing like cuddling up with that morning coffee, watching medical TV dramas, and HIStalk's best news he's heard: Season 1 of St. Elsewhere will finally be available on DVD on Thanksgiving weekend. Not only is it the best medical drama in history, it may be the best TV series ever. I've never seen a TV show that could make you laugh and cry at the same time. ER and its ilk are a pale comparison. "Paging Dr. Howard, Dr. Fine ..."

Topher considers the consequences of that dreaded call from the cute gal you hooked up with the night before -- “I’ve got Chlamydia” and the awful complications it can mean for you.



Party gadflies:

What’s a party without the gadflies that gossip about what’s going on? The great thing about this party is that everyone is invited, including the media, and they’ve been turning out in full force, on TV, in the papers like USA Today, and the New York Times.

Everyone’s worried that some camerapic is going to betray a revealing pose at the party, and here’s an audiocast reviewing PDA phones for use in mobile healthcare.

We're even watched by Search Engines & meme monitoring services:
http://digg.com/health
http://health.netscape.com/
http://dissectmedicine.com/

While on the topic of Search Engines, how could I not mention the buzz about Healia this week (even though this is a Healthline blog, hurrah for editorial independence!):
John Sharp of eHealth (pro)
Carol Kirschner Driving in traffic (pro)
Her doc (pro)
David Williams (con) who provides a detailed example how Google performs better, with a response from Healia in the comments.



Continuing the party, in person:

If you’d like to get together as health & medical bloggers in the real world, there are a few places we’ll be meeting:

CDHCC Dec 11-13 Consumer Directed Health Care Conference at Consumer Health World Located in Washington DC, where I’ll be speaking on Health Blogging.

HealthCamp (in planning) an unconference like BarCamp.

As announced in previous editions of Grand Rounds, The Medical Blog Network and Envision Solutions, LLC are running the first global survey of healthcare bloggers. The final survey results will be presented during Healthcare Blogging Summit 2006 in Washington, DC. Please take a few minutes to learn about and take this important survey. The poll closes this Friday, September 29.

Whoa. What a party. I'm looking forward to the buzz we make, and hope it leads to more conversations about hot topics. Here's to blogging! Cheers!



Thanks to the folks listed below in "links to this post" for the link back, as well as these that google didn't notice:
Dr. Helen, Sunlight Follows Me, Alwin Hawkins, Dr. Emer, The Tundra PA, Kim of Emergiblog, Clinical Cases, HealthyConcerns, PharmaGossip , Alas! Dissect Medicine and Kevin, M.D..

Remember to send your entries for next week's host to Blog carnival at: http://blogcarnival.com/bc/cprof_21.html

If you prefer, send the submission letter to drkavokin at yahoo dot com (remove spaces, place @ and .)

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How to take your daily aspirin if you also use an NSAID - non-steroidal anti-inflammitory such as ibuprofen

If you use pain relievers and have been asked by your doctor to take daily aspirin for your heart or to prevent stroke, the FDA has some important news for you. They've found that aspirin may not help you if you take it at the same time as one of the most common pain killers available over-the-counter, ibuprofen. Ibuprofen goes by the brand names of Advil or Motrin, and are in the class of pain relieving medicines called non-steroidal anti-inflammatory drugs (NSAID) which include many others.

Here's the short story:
- take your daily dose of immediate-release low dose aspirin at least 30 minutes before you ever take ibuprofen and possibly any non-steroidal anti-inflammatory drug (NSAID).
- Otherwise, you should wait at least 8 hours after taking a dose of ibuprofen before taking your daily aspirin dose, in order to avoid preventing the heart-protecting anti-platelet effects of aspirin.

The long story is based on lab research that's a bit complicated. Here's what they found. These findings were based on lab research, which means that they didn't compare how people did who took aspirin together with ibuprofen to people who took them at different times. That kind of research provides the best evidence, since you then know that something bad happened to real people when they took the medications together -- but they didn't do that. The reason the FDA is sharing this information is that it's the first in a series of alerts they intend to give bringing attention to the striking lab research they've done on using these drugs together which has widespread importance, given how many people take these drugs together.

The details of what happens has to do with platelets. Platelets are cells in your blood that allow your blood to clot. Aspirin decreases their stickiness and lessens the chance you'll have a heart attack since part of the blockage of heart arteries is by these platelets. When taking both of these drugs, competitive inhibition takes place between aspirin and NSAIDs for the platelet cyclooxygenase (COX) acetylation site. That means that both drugs are trying to attach themselves to the same spot on a platelet and they both won't fit, only one of them. Aspirin produces its anti-platelet effect by irreversibly acetylating cyclooxygenase that lasts the entire 7 day life of the platelet. That means that aspirin works by sticking to platelets for their whole 1 week lifespan. Ibuprofen and other NSAIDs reversibly bind cyclooxygenase at a nearby site and can physically block aspirin's ability to bind to its active site. They both don't fit, aspirin and NSAIDs. This interference of the heart-protective effect can be avoided by allowing aspirin to arrive to the site before the NSAID. This is the reason for the timing of taking the 2 drugs if you choose to.

Whew. So, if your doctor asks you to, it is safe to take both drugs, minding the timing of when you take them. This is going to be huge news to many people, and watch out for more information as this trickles out.

Many articles at Google News are talking about this...

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Rate of the spread of flu Is linked to airline travel

The New York Times today reports on a PLoS Medicine study by Brownstein, Wolfe & Mandl showing that the rate of spread of influenza is related to the number of people flying in airplanes.

They studied the spread of influenza timed to the amount of air travel from 1996 to 2005. From year to year, the day that marks the highest number of deaths (peak mortality) due to flu is Feb. 17. But following Sept. 11 and the subsequent decrease in air travel, the peak mortality was delayed until March 2.

Considering that during the SARS outbreak, transmission occurred between travelers on the same airplane from Hong Kong to Singapore, it's plausible that air travel poses some risk to contracting not only flu but other infectious airborne illnesses.

The authors argue that in the case of pandemic flu, the government should use restrictions on air travel to decrease the rate of spread:

"Restricting travel would provide critical lead time to stockpile antivirals, develop vaccines, decide on school closures and lessen person-to-person contact," said Dr. Kenneth D. Mandl, the study's senior author.

"Flight restrictions might give us a chance to reduce downstream illness and deaths in a flu pandemic," said Dr. Mandl, an assistant professor of pediatrics at Harvard and an attending physician at Children's Hospital Boston. "If we can provide a month of lead time, that gives us an advantage."

Dr. John S. Brownstein, the paper's lead author and an instructor in pediatrics at Harvard, added that restricting air travel as a pandemic control measure would have major economic and social impact.

"It is for policy makers to decide, and we hope to have provided them with the evidence they need to gauge the possible benefit of that decision," Dr. Brownstein said. "Clearly an air traffic ban would be one of multiple measures that could help mitigate the impact of a flu pandemic."

Hundreds of articles commenting on this at Google News.

References:
Brownstein JS, Wolfe CJ, Mandl KD (2006) Empirical evidence for the effect of airline travel on inter-regional influenza spread in the United States. PLoS Med 3(10): e401.

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Online services help patients deal with their illness and connect with others

The New York Times today highlighted how useful online services have been to patients, both in managing how they feel as well as connecting with their loved ones.

The services highlighted ones devoted specifically to the needs of seriously ill, often hospitalized or otherwise terminally ill patients. These folks are walking such a difficult road, that it helps them to write down how they're feeling. Not only does it provide friends & family an easier way to keep up with their treatment, many also choose to make their writings public to the whole internet and welcome in others in hope that they'll find useful information about dealing with a particular illness.

Companies highlighted included ones focused on cancer such as for-profit CarePages, and non-profit CaringBridge. TheStatus hosts diaries of patients afflicted with many different diseases. These services provide patients with private journals, or allow them to interact with others by making their writing public, connecting them with others interested in how to manage that illness.

In this way, these services can be seen as an illness-focused version of the larger online movements to share with others: weblogs and forums. Weblogs are the accounts of a particular writer, called a blogger, and can be private or public. In fact, you're reading one now. Bloggers often delve into their illnesses since it's just another important part of their lives they'd like to share. Forums are online services where writing on specific topics are collected, rather than focused on the writing of a single author like blogs. Both of these online forms of expression have had explosive amounts of interest with many millions of users sharing their stories.

The process of expressing a difficult event such as serious illness is assisted incredibly when a patient feels useful, understood and loved. In one way, patients feel their stories help others, just as if they were participating in a clinical trial of an experimental medication or treatment. And even if they choose to make their writings private, their loved ones can better support them the more they understand how the patient is doing.

Cheers to these online communities! I'm excited about them, and although I'd never wish you ill, if you do become seriously ill, take a look and see if one of these kinds of services can help you.

Tailrank lists a commenter.

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Does hop flavonol glycoside from beer really alleviate allergy & hay fever symptoms?

Sapporo Breweries Ltd., and Sapporo Beverages Co., Ltd. today announced that they:

have proven that Sapporo beer is effective in mitigating hay fever symptoms. Hop flavonol glycoside extracted from the beer prevents histamine, an allergy-inducing substance.

Sapporo Group conducted a clinical trial of 20 patients with hay fever symptoms and found that 60% them noted less sneezing and 55% noted less runny nose with significant improvements on their symptom-medication scores.

Sapporo has filed a patent application based on the effect of beer on hay fever symptoms. Going forward, the Group will explore the affect of beer on atopy and allergy symptoms related to house dust.

I'd question the power of a 20 patient trial to prove that hop flavonol glycoside provides relief from histamine. It's not that I disagree with their use of a clinical endpoint of sneezing and runny nose (although I suppose you could question what denotes "less" degree of sneezing and rhinorrhea). It's that I wonder if 20 patients is enough to "prove" that this substance relieves allergy symptoms. I'd like to see the study, but alas, I can't find it online.

A complicating factor is that histamine has been found more in foods having undergone fermentation, which is an essential process in producing the alcohol in beer. Ingesting a histamine-reducing diet may be able to help those who suffer from allergies. I wonder what's the histamine content of beer? Hmmm...

If this turns out to really be true it would be interesting to do an observational study on how flushed those who consume beer become versus other forms of alcoholic beverages not based on hops. Asians often flush in response to alcohol consumption even if they don't become inebriated. Histamine has been fingered as a possible culprit, and some people take antihistamines with variable success in blocking this socially embarrassing flushing. Given my observations of the Asians I've seen who consume beer, I'm not sure how well hop flavonol glycoside really blocks histamine.

Many at Google commenting on this.

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FDA fines American Red Cross $4.2M for Donor Violations

The American Red Cross (ARC) is the largest single agency involved with collecting blood for our nation's strapped supply of blood products used in transfusions. Today, the FDA fined the organization $4.2 million, the largest single fine, for violations of FDA rules. These rules include formal regulations regarding the collection of blood, as well as amendments in the form of consent decrees, of which the most recent was in 2003.

It's important to note that the FDA goes out of its way to say that no "serious health consequences" have been found to have resulted from the violations. In fact, they state "Improvements in donor screening procedures and the use of a variety of new tests in the last few years have made the national blood supply safer from infectious diseases and other risks than it has been at any other time. However, because there is always some degree of risk in receiving blood products, each individual safeguard is considered critical to minimizing that risk." It's the broaches of individual safeguards committed by the ARC that the fine today was due to.

This underscores the importance of well trained employees and volunteers in every institution collecting blood for use in our nation's blood supply. Only 10% is collected by hospitals, whereas smaller private local agencies make up the difference, with these agencies providing collections of an amount equal to that of the ARC's. This fine should be a warning to each of these smaller agencies to maintain and improve compliance with the careful screening questionnaires required by the FDA.

I'm hoping that the technologies used in testing also improves such that tainted blood can be discarded before it enters the nation's blood supply. We may never reach 100% safety, but the closer we can get, the better.

231 articles at Google News currently commenting on this topic including:
Physician's First Watch
AP Health wire
Wall Street Journal
Medscape

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Cholesterol and Statins

Since this is National Cholesterol Education Month, I'd like to chime in on the object of what many of you go to health screenings for: testing your cholesterol. Higher levels of bad cholesterol (low density lipoprotein, or LDL) and lower levels of good cholesterol (high density lipoprotein, or HDL) has been linked to heart attacks, strokes, and other diseases decreasing your lifespan. Recent evidence published by the New England Journal of Medicine (NEJM) suggests that it prevents strokes (CVA) after you've had one, or even just a mini-stroke (TIA, or transient ischemic attack).

One practical tip about testing: remember to fast the morning you go for testing or else your triglycerides will be artificially high. Your triglycerides are one kind of cholesterol in your blood.

The thought is that by reducing your bad cholesterol, you won't have excess cholesterol to absorb into the lining of your arteries that form plaques, or hard spots. These plaques can break the lining open, providing a spot for your blood to clot and block flow to the tissues that need it. If this happens in heart arteries, it causes a heart attack. Your heart is a muscle just like the other muscles in your body and need oxygen from blood to run. Your brain needs nutrients provided by blood, and if a brain artery is similarly blocked, you can have a CVA or a TIA.

Statins are a class of cholesterol lowering drugs which block an enzyme involved in the production of cholesterol. The enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase) and statins are called HMG-CoA reductase inhibitors because of this. Other possible ways statins may improve health is by decreasing inflammation that is involved in damaging the walls of arteries and forming plaque.

A disclosure before we continue -- I take Lipitor and chalk it up to my genetics, of course not my passion for french fries and foie gras. Lipitor has been in the press a lot recently, as I pointed out earlier, it's the statin studied in the NEJM article. It's the most popular statin, and accounts for a majority of the profits of its manufacturer, Pfizer. It's become this popular because it's more potent than older statins, many of which have lost patent protection and gone generic. It's also been the statin used in many of the more recent studies showing a benefit to our heart health.

One controversy I've been interested in is the catfight between those who believe in using the drugs listed in these research studies, and those who believe that the heart-protecting qualities of one statin apply to all of the medications in that class. Kaiser, a health maintenance organization or HMO, is a strong proponent of taking higher doses of generic statins to achieve the choleterol lowering that it takes to protect your heart. Some of my favorite bloggers have chimed in against the recent NEJM study, showing the increased company profits from the study, considering one statin equal to another, and troubled that the study focused on a dose of lipitor rather than a level of cholesterol lowering.

Whether you believe in one statin over another - one thing's clear. Lowering your cholesterol by improving your diet and increasing your exercise can help. For some, that's not enough, and a statin can help, like with me! If you're over the age of 25, ask your doctor to test you as part of your health care maintenance, and possibly even if you're younger if you have a family history or risk factors.

95 Commenting on statin & lipitor & stroke at technorati.

Tags: Healthline, health, medical, physician, cholesterol, statin, heart attack, stroke, ethics, class effect, lipitor

Update: Huge thanks to my favorite diabetes blogger Amy Tendrich of Diabetes Mine for presenting this post first in Grand Rounds Volume 2 Number 51. I hope I can be as creative and thoughtful when I host Grand Rounds in 2 weeks. One clarification to readers is that Kaiser uses generic statins at a higher dose to achieve the same lowering of cholesterol that a more potent statin at a lower dose achieves, such as Lipitor. Kaiser believes they can save on costs by using generics and achieve the same health outcome. Companies producing branded statins such as Lipitor are trying to say that cholesterol lowering isn't the only way they help, and that you have to use THEIR drug to get the other effects. That's the purpose of the NEJM study I mention at the beginning of this post.

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Abiomed Implantable Heart Device Receives F.D.A. Approval

The New York Times reports that on Tuesday, Abiomed received FDA approval to sell the world's first fully implantable mechanical heart. The company received a "humanitarian device exemption" since the device demonstrated "safety and probable benefit." Normally to be approved by the FDA, devices must demonstrate "safety and effectiveness," which an expert panel convened earlier this year argued that the Abiomed device failed to demonstrate.

Many congestive heart failure (CHF) patients die waiting for their heart transplant, and this device, with all of its failings, could be a last hope for these patients. It's very exciting to consider that up to 4,000 CHF patients a year, above the age of 18, with less than a month of life expectancy left, will have this as option to give them a few extra months of hope that they could receive a heart transplant.

Past artificial hearts required a patient to be continually attached to equipment that powered and supported the device. The Abiomed device provides an internal battery to allow a patient an hour of disconnected use, and 2 external batteries that allow 2 hours of freedom.

There are many limitations, including the need for a patient be able to tolerate blood thinning medicines to prevent blood clots, as well as have a large enough chest cavity to hold the device. Even with the limitations, hopes are that more experience with this device will provide important research to develop improved mechanical hearts that are available for use by less severely ill patients, and eventually for permanent implantation.

Others commenting on this topic:
384 articles at Google News.
Washington Post:

"In the opinion of most health policy experts, that is not a cost-effective use of resources," said Sean D. Sullivan, director of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington. "Most cancer biologics [biotech drugs] that extend life by four to five months are about one-third or one-quarter the cost of this artificial heart."

MedGadget & update.
The editors of the American Journal of Bioethics express caution.
EARTHtimes.org
Sci-Tech Today gets the story wrong: they state "it is likely the last heart they'll have" although this device is intended to be a bridge device until a transplant is available.
KevinMD: "It just doesn't fit in most people"
Daily News Central

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