We have accepted the suggestion from a BU family member to facilitate discussion on medical matters which is a topic area that should interest us all. Based on our exchanges with and between BU family members posted over time, many of you work in the medical field or possess information on various medical issues acquired due to personal circumstance or otherwise. Medical Corner seeks to encourage ANYONE to submit views on medical experiences earned, new developments in the industry or any related matter which readers feel can serve to educate the BU family of a medical nature.
View the new page which appears at the top of the BU homepage to make your comments.
10 responses to “New Page Added”
excellent idiea BU well done
Great idea.
Can we use the page to ask for fellow readers’ suggestions? Like recommending a medical practice where the treatment/service has been particularly good?
The dedication by BU of a subject area on the blog that will deal with medical, health and nutritional issues, matters and developments affecting medical, health and nutritional professionals, technicians, students and institutions as well as many other persons and other entities on the whole in Barbados and elsewhere, and whereby BU as well as the friends and patrons of BU and those above mentioned professionals, technicians, students and others here and outside of Barbados, will directly be able to make such submissions with a view of seriously discussing and providing solutions to many of the problems associated with those kinds of issues, matters and developments, must be seen by PDC as very welcome and thoughtful, indeed.
Surely, BU and the person proposing the idea must be commended for such foresight and action in thought. There is no doubt about it that the current state of medical, health and nutritional affairs of Barbados and other countries must be seen as having paramount importance in any quest to achieve greater national social, political, material and financial growth and development for our respective countries, now and in the future, and especially, given the present scale of medical, health and nutritional challenges posed to our respective countries.
PDC
The creme de la creme of the Medical cultures in the USA have found that the Cholesterol drug Vytorin failed in tests to show that it is any good and patients are being told to stick with statins like Lipitor.
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I have not read any articles that said that Vytorin is no good or that patients should stick to Lipitor.
What has been reported though, is that while Vytorin reduced levels of LDL, or bad cholesterol, in a group of 750 patients, it had little effect on the buildup of plaque in the arteries, a harbinger of heart attack and stroke.
Vytorin is a combination of Ezetimibe and Simvastatin.
Ezetimibe reduces blood cholesterol by inhibiting absorption of cholesterol by the small intestine by acting at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver.
Simvastatin is a statin. That is it works by inhibiting the activity of the enzyme HMG-CoA reductase that is necessary for the body to make cholesterol.
The rationale for the production of Vytorin was to make a drug that would be additive or synergistic by attacking cholesterol levels by attacking two mechanisms of action instead of one.
In fact Vytorin (the combination of Ezetimibe and Simvastatin) is the only product to treat both sources of cholesterol; absorption in the intestine of both biliary and dietary cholesterol, and production in the liver and peripheral tissues.
It was thought that the treatment of high cholestrol from both sources was likely to result in lower cholesterol levels, particularly LDL cholesterol. In a clinical study, it was shown that the combination of Ezetimibe and Simvastatin was superior to the statin Lipitor in lowering LDL cholestrol.
So to pontificate that Vytorin failed in tests to show that it is any good, is as accurate as saying there are NO bridges in Bridgetown, because even the controversial Enhance study revealed the fact that Vytorin showed a huge LDL reduction. In other words the drug is indeed efficacious, i.e it has done the job for which it was designed. In fact the reviewers also conceeded that Vytorin reduced three key risk factors of heart disease- which is the purpose of attempting to reduce cholesterol levels.
The creme de la creme of the Medical cultures in the USA have found that the Cholesterol drug Vytorin failed in tests to show that it is any good and patients are being told to stick with statins like Lipitor.
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I have not read any articles that said that Vytorin is no good or that patients should stick to Lipitor.
What has been reported though, is that while Vytorin reduced levels of LDL, or bad cholesterol, in a group of 750 patients, it had little effect on the buildup of plaque in the arteries, a harbinger of heart attack and stroke.
Vytorin is a combination of Ezetimibe and Simvastatin.
Ezetimibe reduces blood cholesterol by inhibiting absorption of cholesterol by the small intestine by acting at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver.
Simvastatin is a statin. That is it works by inhibiting the activity of the enzyme HMG-CoA reductase that is necessary for the body to make cholesterol.
The rationale for the production of Vytorin was to make a drug that would be additive or synergistic by attacking cholesterol levels by attacking two mechanisms of action instead of one.
In fact Vytorin (the combination of Ezetimibe and Simvastatin) is the only product to treat both sources of cholesterol; absorption in the intestine of both biliary and dietary cholesterol, and production in the liver and peripheral tissues.
It was thought that the treatment of high cholestrol from both sources was likely to result in lower cholesterol levels, particularly LDL cholesterol. In a clinical study, it was shown that the combination of Ezetimibe and Simvastatin was superior to the statin Lipitor in lowering LDL cholestrol.
So to pontificate that Vytorin failed in tests to show that it is any good, is as accurate as saying there are NO bridges in Bridgetown, because even the controversial Enhance study revealed the fact that Vytorin showed a huge LDL reduction.
In other words the drug is indeed efficacious, i.e it has done the job for which it was designed. In fact the reviewers also conceeded that Vytorin reduced three key risk factors of heart disease- which is the purpose of attempting to reduce cholesterol levels.
The report claims “doctors were stunned to learn that Vytorin failed to improve heart disease even though it worked as intended to reduced three key risk factors”.
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Again I found no articles that Vytorin failed to improve heart disease. Rather, the two year ENHANCE Study, released by the manufacturer as an abstract recently, revealed that Vytorin failed to provide evidence that ezetimibe/simvastatin was better than the statin simvastin in terms of achieving a lower change from baseline in carotid intima media thickness despite lowering LDL levels in a population of patients with heterozygous familial hypercholesterolemia (a form of high cholesterol that affects less than 1% of patients).
Clinical events such as heart attack and stroke were not measured as primary or secondary endpoints of the study making it impossible to determine Vytorin’s effect on these events. Data from studies specifically designed to answer this question are expected within the next few years.
This report points out that Vytorin (i.e the combination of ezetimibe & simvastatin, working at two different sites in the body)lowered LDL levels.
The study was done not on “normal” folk with raised cholesterol levels, but with a population of patients with heterozygous familial hypercholesterolemia – whose high cholesterol levels are not acquired but are inherited.
What is clear is that the patients in the study weren’t exactly typical—all had extremely high LDL levels of above 300 because of a genetic condition. So whether the results of the study are relevant to individuals with more-typical LDL isn’t clear.
Since heart attack and stroke were not measured as primary or secondary endpoints of the study, how can one say that the drug failed to improve heart disease, or be stunned because plaque buildup was not also lowered?
Maybe it would be lowered in folk with non familial hypercholesterolemia. Perhaps the lowered cholesterol may be found in the body of the increased plaques. Perhaps it matters how you lower cholesterol, not just how much you lower cholesterol.
The study also indicated that Vytorin wasn’t any better than the same dose of the statin simvastin alone at keeping fatty plaque from building up in the arteries of the neck.
As fatty plaque builds up, it increases the thickness of the walls of the carotid arteries in the neck; progressive thickening is a good indicator of cardiovascular risk. In the Enhance study, on average, the thickness in both the simvastin alone group and the Vytorin group increased (very slightly) during the two-year study.
The point is this was not the definitive or primary reason for which either of these drug were made.
What is all the fuss about? Only that Vytorin is very much more expensive than using the statins alone, and is not special in any other way?.
Let me invite all who want to know the truth about Vytorin to bring up Google and read the many convincing articles about the failing grades this drug has accumulated.
Cardiologists of prominence and the major medical cardiology cultures have accepted that Vytorin is a failure.
More importantly look at the article where the US Congress is accusing Schwring-Plough Corp and Merck Co of purposely witholding the results of an extensive study that showed Vytorin a failure. Read all of this yourself !
I for one would think that if the Congress of the USA is accusing the makers of Vytorin of wrongdoing or a cover up this in itself speaks volumes of the usefullness of the druf itself
Let me invite all who want to know the truth about Vytorin to bring up Google and read the many convincing articles about the failing grades this drug has accumulated.
Cardiologists of prominence and the major medical cardiology cultures have accepted that Vytorin is a failure.
More importantly look at the article where the US Congress is accusing Schwring-Plough Corp and Merck Co of purposely witholding the results of an extensive study that showed Vytorin a failure. Read all of this yourself !
I for one would think that if the Congress of the USA is accusing the makers of Vytorin of wrongdoing or a cover up this in itself speaks volumes of the usefullness of the druf itself
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If any of my medical students were to write such bullshit, I would fail him statim!
I too have Googled and found the many articles about Vytorin, to which you refer and have read them myself.
Now I invite you to give links to these artricles that say “Cardiologists of prominence and the major medical cardiology cultures have accepted that Vytorin is a failure.”
The drug was shown in clinical trials in 2004 to reduce LDL levels. That is the primary purpose for which the drug was made. In basic pharmacology that means that the drug is efficacious.
It binds to the appropriate receptor sites, and exerts the effect for which it was designed. That it reduces levels of LDL, or bad cholesterol makes the drug usefull and efficacious.
Vytorin has been found to be most useful for patients who aren’t getting all the help they need from statins and for those who can’t tolerate statins’ side effects, including liver problems. I repeat the drug is thus useful and exhibits the pharmacological property of EFFICACY!
The Enhance study involved 720 patients with very high levels of cholesterol from an inherited form of heart disease. The study was designed to prove that Vytorin could slow the growth of plaque in carotid arteries supplying the brain more than simvastatin alone.
The ENHANCE study was conducted in 720 patients with heterozygous familial hypercholesterolemia, a genetic disease that can boost untreated cholesterol levels above 300. That high level of cholesterol makes them more likely to have heart attacks, and it should make it easier to cut down on the buildup of artery plaque.
What were the findings?
The researchers found that even though Vytorin dramatically reduced bad-cholesterol levels, it did not slow the growth of artery blockages more than generic Zocor.
It showed that though the patients on Vytorin had a 58% drop in LDL, or bad cholesterol, after two years compared to 41% for Zocor, the change in artery plaque was no different–if anything, it was a little worse for Vytorin.
What does this mean ? It means that Vytorin does NOT slow the growth of artery blockages more than generic Zocor. It means essentially that using a combination drug that worked by two different mechanisms of action failed to show the added or synergistic effect that was expected or hoped for. It does not say that the drug was useless, or non efficacious.
The Enhance study only shows that the drug does not ALSO reduce the buildup of plaque
The ENHANCE study was never designed to provide outcomes, meaning the prevention of major adverse cardiovascular events such as heart attack or stroke. It was an interesting scientific exercise to look at the impact of the drug on plaque, which is itself a surrogate end point for these events.”
How can it be that a drug that dramatically lowers bad cholesterol doesn’t reduce plaques? The answer isn’t clear. This means further research is needed.
The medical profession knows that statins lower the risk of heart disease by doing more than just lowering cholesterol — studies have shown that statins can also lower inflammatory factors that can aggravate plaques, causing them to burst and block heart arteries, as well as reduce amounts of triglycerides, a particularly dangerous form of fat for the heart. But the stains have been around for a while.
The medical profession knows that Vytorin blocks absorption of cholesterol, but does not know what else it block s. Does it block something else in the diet that could be beneficial? This means that further studies must be done. Not that the drug is useless or non efficacious.
Did you also read that “the American College of Cardiology released a statement suggesting that “major clinical decisions not be made on the basis of the ENHANCE study alone”, given the small and unique patient population, 720 patients in an Amsterdam hospital with heterozygous familial hypercholesterolemia.”
Do you understand what that statement says? Do you understand what is meant by a “small and unique patient population” “with heterozygous familial hypercholesterolemia.”
Did you also read or understand the report that pointed out that the patients in the study “presented a major challenge, partly because their cholesterol was so high. Also, most of them had already been treated with statins, making it harder to see any additional benefit. “
Did you also read that Merck and Schering Plough have reported that they have three larger trials currently underway to focus on outcomes, measuring the drug’s effect on heart attacks and strokes in patients.
Another study, called ASAP, conducted by some of the same experts who ran ENHANCE, compared the top dose of 80 milligrams of Pfizer’s Lipitor with the second-highest dose of Zocor. It studied a similar group of patients, people who have a genetic disorder that predisposes them to have high cholesterol. Bad cholesterol, or LDL, was cut 50% on Lipitor, compared to 41% on Zocor. But while artery thickness increased by 0.036 millimeters on Zocor, it actually decreased by 0.031 mm on Lipitor.
In other words, Lipitor succeeded where Vytorin failed. In the ASAP trial that compared Lipitor and Zocor, patients had arteries that were about 0.9 mm thick. By comparison, the patients in the ENHANCE study comparing Vytorin and Zocor had arteries that were only 0.7 mm thick.
It may very well be that these newer patients may have already had a lot of gunk yanked out of their arteries by years of statin treatment. More research is needed.
You obviously read that “A congressional committee said in December it will investigate allegations that the companies that make the drugs, Merck and Schering-Plough, delayed releasing data from the study, completed in April 2006. “ But the fact that the Congress of the USA is accusing the makers of Vytorin of wrongdoing or a cover up does not say anything about the usefulness of a drug. Since when does the members of the US Congress have qualifications in Cardiology or Pharmacology- or you for that matter?.
Your post on BU which attempts to show that my first posts were erroneous only indicates that whereas one can buy a computer and come on the net and write bullshit, it does not mean that they know what they are talking about.
Your post on BU which attempts to show that my first posts were erroneous only indicates that you are unable to read medical literature. This is not reading the Nation. Medical students are taught how to this.
By the way is a “cardiology culture” something that grows in a lab?:
And please note also that a study with a sample size of just over 700 is not extensive as you pontificate in your obvious ignorance.
You are clearly not a cardiologist, or Pharmacologist or a real scientist of any sort. You are clearly out of your league. You are not qualified to opine, because you do not know even the basic principles of the subjects involved here.
GP, why you want to mimic PDC with that long, long post. Whew!
I hope I am qualified to ‘opine’ that thought. LOL.
GP you are acting like a snob. Maybe you should be the only one allowed to post on medical issues. I did tell you already that you are the resident expert.
Jeez. Let’s see you rise to the top here now.
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