You’ve got to be asking yourself if medical device companies are going to feel the effects of this finding: the utilization of coronary stents in the treatment of heart disease becomes less crucial the longer the patient survives this particular diagnosis; that is, the role of medical (non-surgical) therapy leads to — at the very least — equivalent outcomes in the long run. According to the NEJM:
The equivalent benefit seen after 36 months for optimal medical therapy alone, reported in the Aug. 14 issue of the New England Journal of Medicine, was the latest finding to emerge from the 2,287-patient COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial. It was designed to compare the efficacy of [stenting vs. optimal medical therapy].
[…]
In the stent group, patients who had the most severe angina at baseline received the greatest benefit….The incremental benefit for stenting was apparent for six to 24 months, and then the two groups began to converge because “there was significant and rapid improvement in Seattle Angina Questionnaire scores among patients in the medical therapy group,” wrote Dr. Weintraub and colleagues.
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For those who thought that the racial disparity in healthcare was just limited to the treatment of disease, they should consider the effect of perceived discrimination and bias on minority patients with respect to disease screening and preventive care. From the American Assn. for Cancer Research:
“We have yet to achieve bias-free health care. This has serious public health implications as we know that higher levels of screening lead to lower levels of mortality. Clinicians need to be aware that they may be sending signals, even unintentionally, that lead minorities to believe they are being discriminated against,” said LaVera M. Crawley, M.D., M.P.H., an assistant professor at the Stanford University Center for Biomedical Ethics. Exactly what those signals are will need to be determined in future studies, Crawley says, but the relationship between perceived discrimination and failing to get regular screenings is strong.
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- Federal panel: stop prostate exams at 75 years of age.
Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor. The new guidelines go one step further, saying, in effect, why test if the patient is unlikely to be treated? The guidelines, published in the Annals of Internal Medicine, are only recommendations, but they are relied on by many physicians in determining patient care. The recommendations could therefore trigger a decline in prostate cancer testing in the elderly. The recommendations provoked a backlash from some experts.
- So much for privacy concerns. Apparently more UCLA Medical Center employees helped themselves to celebrities’ medical records.
- Can estrogens relieve psychosis in women with schizophrenia?
Schizophrenic women who get an estrogen patch along with their regular antipsychotic medications have fewer symptoms than women who get inactive placebo patches. The finding, from a four-week study of 102 women of childbearing age with schizophrenia, comes from Jayashri Kulkarni, MBBS, PhD, and colleagues at Monash University in Melbourne, Australia. During her psychiatric training, Kulkarni spoke with many schizophrenic women who kept telling her, “It’s my hormones, Doc.” They also told her, “No one takes any notice when I say that it’s to do with my hormones.” Kulkarni took notice. She and her colleagues have now completed a series of small studies showing that estrogen can be very effective in reducing symptoms such as delusions, hallucinations, and disordered thinking.
- What to the Democrats think of Obama’s message of healthcare reform? Why, they’re all for it.
- Since 2000, the World Bank has spent over $1.6B to combat AIDS-related illness in Africa. But is it enough?
Thought tuberculosis (TB) was an afterthought? Think again. The rates of the most difficult to eradicate strains — the so-called multi drug resistant (MDR) strains — are creating concern in the epidemiological and public health spheres. Although not a major problem in this country, the rates of MDR-TB are climbing in developing nations. The use of what is called “directly observed therapy“, a mode in which patients must take treatment under the supervision of a public health entity, is becoming increasingly challenged practically everywhere. That fact doesn’t bode well for keeping a key infectious disease as contained as it previously was just a few years ago. | LINK
On the heels of a call to arms by various organizations and think tanks to meet the HIV/AIDS crisis head on in the African-American community, comes news from the CDC that, overall, almost 60 000 people become infected with the virus annually in this country. As methods for detection of the virus have become more rapid and precise, the sobering realization that the epidemic is worse than previously thought is starting to set in for epidemiologists and activists alike. | LINK
- There’s a new technique for culturing neurons, the functional units of the nervous system; it may shed light on the origins of amyotrophic lateral sclerosis (Lou Gehrig’s disease).
The new cells were derived from 3-millimeter patches of skin removed from the arm of an 82-year-old woman and her 89-year-old sister, who share a rare genetic mutation that causes about 2% of ALS cases.
The scientists from Harvard University and Columbia University focused on the rare form of ALS in part to test whether cells from elderly patients could be reprogrammed, said biologist Kevin Eggan of the Harvard Stem Cell Institute.
“This opens the door to being able to make patient-specific stem cell lines from diseases which affect people very late in life, like Parkinson’s disease or Alzheimer’s disease,” said Eggan, the study’s senior author.
- The race to the finish line for anti-Alzheimer drug development may prove to be a risky proposition for pharma and its research.
- The House of Representatives moves to give the FDA power to regulate tobacco products. Great news.
- CMS: Medicare payment rates to long term care facilities to increase by over three quarters of a billion dollars next year.
Medicare payment rates to nursing homes will increase by $780 million next year, the Centers for Medicare & Medicaid Services (CMS) announced.
The boost in payments is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services included in a skilled nursing facility stay.
- Michigan physicians are upset over EPA’s decision to allow the state to use a certain antibiotic to “treat” diseased apples.
If there were no other reason to support the fact that African-Americans are an underrepresented demographic with respect to the access to healthcare in this country, one would have to look no further than statististics outlined in a recent report [PDF] prepared by the healthcare think tank, Black AIDS Institute. Besides characterizing the inadequate healthcare support for blacks living with HIV in this country as “lethargic and often neglectful”, one of the report’s co-authors calls for what, in essence, would be a global “shout out” to healthcare leaders of the dire circumstances of this disease’s most numerous silent minority. | LINK
The aging of our nation has brought us more than a heightened sense of healthful well being, it has also pushed the concepts of preventive care and chronic disease management well beyond the pages of medical literature. Besides patients and doctors; healthcare organizations, third party payers, the federal government (Medicare) and disease-oriented associations are claiming a bit of the pie with respect to the constant flow of information about these issues.
Lately, the target condition is diabetes. Or, rather, pre-diabetes.
Pre-diabetes occurs when blood sugar levels or impaired glucose tolerance is elevated, but not quite to the point defined as diabetes. More than 56 million Americans currently suffer from pre-diabetes, according to the U.S. Centers for Disease Control and Prevention.
“Diabetes has become the major problem in the United States,” Dr. Harold Lebovitz, a professor of medicine at the division of endocrinology and metabolism/diabetes at the State University of New York Health Sciences Center at Brooklyn, said during a noon teleconference Wednesday. […]
“The issue is, do you wait until patients really develop these catastrophic complications?” Lebovitz said. “Last year, it cost $170 billion in direct and indirect costs to take care of people with diabetes.”
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Complacency is the assumed response to HIV as an all-encompassing term. It follows, then, that the response to the following troublesome statistic will probably be met with relative inaction, at least initially.
AIDS rates in the nation’s Latino community are increasing and, with little notice, have reached what experts are calling a simmering public health crisis. Though Hispanics make up about 14 percent of the U.S. population, they represented 22 percent of new HIV and AIDS diagnoses tallied by federal officials in 2006. According to a survey by the Kaiser Family Foundation, Hispanics in Washington, D.C., have the highest rate of new AIDS cases in the country.
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The Sophisticated Lady has been diagnosed with hepatitis C, the virus — which in some — may be pre-cancerous or a cirrhotic harbinger. The media say she’s “lucky” to be responding to treatment, a mix of anti-neoplastics and antivirals. Surmised to be secondary to her much publicized battle with drugs in the 1980s prior to her latter-decade career resurgence, the infection was found on routine screening during a physical checkup. | LINK
This item really isn’t news to those of us in the know, mainly the stellar cadre of providers who care for the senior set every day, but it is a milestone nonetheless. We’ve known that this demographic pearl was coming, and the fact that it is occurring in the nascent 21st century bodes well for its inclusion as a healthcare policy issue:
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While not projecting an outright contradiction to the results of the classic U.K. study from the mid-1990s, results from recent U.S. and Australian trials on the intensity of serum glucose lowering in Type II diabetics are reason for some concern, at least from a primary care point of view. The ACCORD and ADVANCE trial results are summarized in the latest issue of the New England Journal of Medicine [PDF here].
Essentially, neither study found evidence to support the widely held belief that aggressive reduction of blood sugar, to below the 7% standard (glycosylated hemoglobin), significantly reduces cardiovascular risk and death for patients with Type II diabetes. That is, patients who were restricted to this type of intensive regimen (which was not standardized with respected to the combinations of drugs and insulin used) showed no measurable decrease in all-cause mortality from risks incurred by existing heart disease during the trial period of intensive control.
While not actually advocating lesser control of one’s diabetes, researchers involved with these trials do suggest that the overriding goal should be one gaining moderate control of blood sugar to protect against eye, kidney and nerve disease, but not for protecting against heart disease, for which other measures, like drugs to control cholesterol, reduce blood pressure and reduce risk blood clotting, as well as changes to diet and exercise, are probably more effective and safer. | LINK
