est. 2007

Barbados Underground

Bringing News and Opinions to the People

Medical Corner

David
1 minute

image-thumb.pngWe 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 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 based on personal circumstance or otherwise. Medical Corner seeks to encourage ANYONE to submit views on medical experiences, new developments in the industry or any related matter which readers feel can serve to educate the BU family.

New Page Added

353 responses to “Medical Corner”

  1. David Avatar
    David

    We have posted the first suggestion which the BU member submitted for consideration:

    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. The report claims “doctors were stunned to learn that Vytorin failed to improve heart disease even though it worked as intended to reduce three key risk factors”. Maybe Barbadians are taking this drug and information like this could be very useful to them. Plus I thik that were you to start such a section it could well pull in people to read your blog who has no interest in the present give and take.

    Another significant announcement this week by the American Heart Association says it endorses “hands-only” method over mouth to mouth resuscitation for keeping heart attack victims breathing until medical help arrives. As you know many people are reluctant to give mouth to mouth but knowing about hands only resuscitation being accepted might be more inclined to help victims in distress.

  2. New Page Added « Barbados Underground (BU) – bringing the news to the people

    […] Medical Corner […]

  3. only me Avatar
    only me

    excellent idiea BU well done

  4. samizdat Avatar
    samizdat

    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?

  5. The People's Democratic Congress / Avatar
    The People’s Democratic Congress /

    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

  6. The People's Democratic Congress / Avatar
    The People’s Democratic Congress /

    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

  7. Georgie Porgie Avatar
    Georgie Porgie

    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.

    ================================
    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.

  8. Georgie Porgie Avatar
    Georgie Porgie

    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.
    ================================

    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.

  9. Georgie Porgie Avatar
    Georgie Porgie

    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”.
    =================================
    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?.

  10. Subscriber Avatar
    Subscriber

    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

  11. Georgie Porgie Avatar
    Georgie Porgie

    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
    ==============================
    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.

  12. Sam Gamgee Avatar
    Sam Gamgee

    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.

  13. David Avatar
    David

    Actually we feel fortunate to have a resident medical member on board to answer the concerns of commenters. We found the response quite enlightening. Sam Gamgee you are welcome to comment or introduce new information as well.

  14. Georgie Porgie Avatar
    Georgie Porgie

    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.

  15. Georgie Porgie Avatar
    Georgie Porgie

    In all fairness , it is quite possible that Subsriber was influenced by this paragraph by one doctor who he calls crème de la crème.

    “This drug doesn’t work. Period. It just doesn’t work,” said Steven Nissen, head of cardiology at the Cleveland Clinic. U.S. Rep. Bart Stupak, a Michigan Democrat helping to lead a congressional investigation of the study, said, “It is easy to conclude that Merck and Schering-Plough intentionally sought to delay the release of this data.”

    But this is a stupid statement to make by a “crème de la crème” doctor as it is most irresponsible, especially since it is well known that Vytorin reduces bad cholesterol, or LDL as it was designed to do.

    What Subscriber failed to notice- and what is more poignant, is that the very same maguffy Steven Nissen has himself said that lowering bad cholesterol, or LDL, is the “cornerstone” of cholesterol therapy. “Any way you can lower LDL cholesterol,” Spiegel says, “lower is better.”

    Since the ENHANCE study showed a reduction in LDL levels for patients on Vytorin Steven Nissen (the “cardiology culture”) has.contradicted himself. Not only has he spat in the air, but the spittle has descended in his face.

    What Subscriber failed to notice also was that another “crème de la crème” doctor, Prediman K. Shah, director of cardiology at Cedars-Sinai Medical Center in Los Angeles, pointed out is that “Doctors had thought that lowering bad cholesterol, or LDL, was always good. But in this study, LDL was cut 40% more for the people on Vytorin than those on the older drug Zocor, yet there was no benefit in terms of preventing the buildup of artery plaque.”. “It certainly throws a monkey wrench into this whole field,” he said.

    The disappointment with Vytorin is not that it is not efficacious (useful for what it was primarily designed) but that it failed to meet the great expectation of achieving an additive (synergistic) effect when used with a statin.

    In fact Subscribers “crème de la crème” doctor and “cardiology culture” Prediman K. Shah noted that Vytorin, which is a combo pill of Zetia and generic Zocor, have a place in the cardiology arsenal. He believes future studies measuring whether Vytorin prevents heart attacks, strokes, and deaths better than Zocor alone are likely to come out positive. So does Roger Blumenthal, head of preventive cardiology at Johns Hopkins. “I’m much more optimistic than Steven Nissen,” Blumenthal says.

    Clearly then Subsrciber needs a lesson in reading the literature.

    To those who feel I am a snob, note that lose bowling is supposed to be put away ruthlessly.

    There is a need for this page in the BU blog to maintain a higher standard than the daily blurr that is spewed out everyday- often with no rhyme or reason or logic.

  16. Subscriber Avatar
    Subscriber

    I am not a medical doctor and my contribution was in the field of being a the “messenger” of what has been said on TV, reported in the newspapers, including Reuters, etc. about Vytorin and the results of the “test”!

    I thought it useful to put this information in the “corner” for the sole purpose that anyone using Vytorin would be aware of the study and maybe want to discuss it with their doctors.

    None of what I said was intended to put me in the position of being an expert in medicine or pharmaceutical products. I merely quoted what was put in the public forum and the many different opinions expressed by eminent cardiologists about the study.

    Obviously my efforts were considered by GP to be “loose” bowling and he/she decided to hit me for “six”. So be it!

    My position still is, as a layman, I want to know all about any medication I am given. And that when a study of the kind that was done on Vytorin shows the rersults it did. And which was followed by many different opinions as to its significance by very prominent Cardiologists as a patient, I would want to err on the side of caution and discuss the matter with my doctor.

    Another point I think GP should consider is this. Though he is entitled to his opinion it is quite obvious that other eminent doctors do not all agree with him and only time and perhaps further tests on Vytorin will shed more light on the present controversial subject.

    Another point I would like to make is this. Whether a commenter is considered as in this case GP claims to be talking loosely deserving his wrath look at the benefit it brought to all reading this post and is this not what the “corner” was started for.

    When commenters whether it is in the “medical corner” or the mainstream blog is treated like garbage how many do you think will contribute? And whose loss is it?

  17. Student Avatar
    Student

    I would be interested to hear Georgie Porgie’s views on how the study of modern genetics can advance helathcare i.e.the medical solutions and the ethical considerations. I am in favour of involving stem cell learning going forward.

    PS. Georgie Porgie can you validate your contributions by publishing your title and quals?

  18. Georgie Porgie Avatar
    Georgie Porgie

    Subscriber says
    And that when a study of the kind that was done on Vytorin shows the results it did. And which was followed by many different opinions as to its significance by very prominent Cardiologists as a patient, I would want to err on the side of caution and discuss the matter with my doctor.
    ===============================
    Can you understand anything that I am saying?

    You are defending your narrow emotional understanding of press articles that have you fearful or suspicious or who knows what.

    You are not listening to what is the clear understanding of the pharmacology of the drugs. Nor are you understanding what the study has indicated.

    The study on Vytorin has revealed that further studies need be done to elucidate what is involved in cholesterol absorption and how anti-cholesterol medication decreases plaque.

    The Enhance study was a poor study because it had a small sample, and it used patients with very high cloesterol levels because of the fact that the participants have hereditary hypercholesterolemia. The subjects chosen were not the run of the mill patient with raised cholesterol levels.

    Off course you should discuss the matter with your doctor, but as I clearly pointed out, I read the same articles you read that caused your concern.

    They all said that Vytorin is not useless as one very prominent Cardiologists carelessly opined. The drug was shown even in the Enhance study to lower LDL- as it was designed to do. Can I get you to see that?

    The study showed that it did not decrease placque to the degree hoped for when given with a statin, which is known to do so.

    It was hoped that the two cholesterol lowering drugs in Vytorin would achieve an effect of 1 + 1 = 2. But it didn’t. That is not unusual. Very often the results expected in research are not what is expected.

    What must be done is to find out why. Such information might them put the profession or the pharmaceutical industry in a position to find a drug that will reduce plaque to the levels desired.

    Subscriber says
    .
    “……it is quite obvious that other eminent doctors do not all agree with him and only time and perhaps further tests on Vytorin will shed more light on the present controversial subject.”

    Clearly further research is needed. The articles you read said so, and so did I.

    The articles you and I both read said that further investigations were going on.
    This is often the result of a study. It may produce that further research be done to get questions. In this case Why did 1 +1 did not produce 2 or even 3 in the use of two drugs BOTH KNOWN TO LOWER HDL.

    Time will also help us to elucidate the issues. That is why smart doctors dont rush to use all the new drugs on the market. Overtime a lot more is often revealed about a drug than is revealed at clinical trials.

    Eminent doctors can say what they wish, but they all know and agree that the drug is efficacious for the indication for what it was primarily produced— that is it works at another site than the statins and it does reduce HDL cholesterol. So to say it is useless is RECKLESS!

    There is no controversy. The controversy exists only in the minds of the press, and persons who can not understand what the literature is pointing out.

    Subscriber if you want to be a messenger and put to information in the “corner” “for the sole purpose that anyone using Vytorin would be aware of the study and maybe want to discuss it with their doctors” that is good, but when you chose to indicate or suggest that I am incorrect, I will respond as I did.

    Subscriber further opines.
    Whether a commenter is considered as in this case GP claims to be talking loosely deserving his wrath look at the benefit it brought to all reading this post and is this not what the “corner” was started for.
    When commenters whether it is in the “medical corner” or the mainstream blog is treated like garbage how many do you think will contribute? And whose loss is it?

    Your well meaning post can only be beneficial to those who read the post if the readers learn from it. You assumed that I am not a crème de la crème cardiologist, and therefore that I am not capable of reading the literature. Consequently, when I gave an accurate and well meaning interpretation of the articles, you invited folk to google and read for themselves as though I was talking nonsense . It did not occur to you that what I was saying could be correct. That sort of BS is like a juicy long hop that must be dispatched with contempt to the boundary.

    I never pontificate on stuff that I do not understand

  19. Georgie Porgie Avatar
    Georgie Porgie

    Student
    Genetics and stem cell learning is not my forte.

    My title and qualifications will not necessarily validate my contribution to this post.

    If you will read any basic note online or in a pharm text on Pharmacokinetics and Pharmacodynamics you will find out about the basic principle of efficacy.

    Similarly if you google Vytorin and Zocor you will find the “controversial” articles and learn of the mechanism of action of these drugs and their effects and indications.

    That will be much more useful.

    Reading this info will show you that you don’t have to be a crème de la crème US cardiologist to understand what I have written in my posts.

  20. Subscriber Avatar
    Subscriber

    Physician heal yourself I have nothing further to say.

    I would hate to be a patient of yours or a student.

    Your philosophy on life and advice to others is every thing printed or spoken by anyone except you is nonsense and you are the worlds medical authority and expert. One wonders why you are in Barbados and not at John Hopkins, the Mayo Clinic, Cornel etc. Maybe you are the spokesperson for the agent in Barbados carrying Vytorin who knows that might explain your tunnel vision.

    You are full of yourself and full of crap. Nothing more from me on the subject so knock yourself out with further drivel!

  21. Georgie Porgie Avatar
    Georgie Porgie

    Subscriber

    Physician heal yourself I have nothing further to say……… Nothing more from me on the subject so knock yourself out with further drivel!
    ================================

    Good Idea! You have said nothing except introducing the subject. And you show a penchant and inability to learn except from folk from John Hopkins, the Mayo Clinic, Cornel etc.—- the crème de la crème and “cardiology cultures”, and what is printed..

    FYI: I am not in Barbados nor am I the spokesperson for the agent in Barbados carrying Vytorin. I do not use Vytorin, nor have I ever written it. It is too expensive, and new!
    I have no tunnel vision about Vytorin. All I have done is try to clearly explain what the articles you read said, the basic Pharmacology of Vytorin, and the pharmacology concept of EFFICACY!.

    You would love to be a patient of mine or my student, because I am a great teacher. But I don’t accept BS!

    Re Your philosophy on life and advice to others is every thing printed or spoken by anyone except you is nonsense and you are the worlds medical authority and expert.

    No. I am not the worlds medical authority and expert, but I do teach and understand Pharmacology, and I do understand how to read the medical literature. If you understood one simple thing that is taught in the first Pharmacology classes- THE CONCEPT OF EFFICACY, you would know that I am not talking drivel, but rather I have given an erudite exposition of the subject. My argument revolves around the principle of efficacy.

    One of your problems is that you dont think that a person from Barbados should be able to disagree with what you see reported in the press.

    Every well taught doctor learns that NOT EVERYTHING printed in the medical litterature is necessarily true. IT DOES NOT MATTER WHO WRITES IT

    Again let me say it again like the patient teacher I am. Vytorin is indeed efficacious in lowering HDL cholesterol- its primary indication. Even the crème de la crème’s believe this. That’s why the drug was used in the Enhance trial in the first place!

    The crème de la crème also use Vytorin in patients that do not respond to, or tolerate the statins. So it has been proven useful or efficacious again. Thats why the drug sells in the billions yearly since introduced in 2004.

    The Enhance study sought to show that the two components in Vytorin would achieve a 1+1= 2 or 3 additive or synergistic effect in lowering HDL. It did not. Nor did the simultaneous use of the two components in Vytorin achieve a 1+1= 2 or 3 additive or synergistic effect in lowering plaque formation.

    I have correctly and fairly interpreted and explained the basic Pharmacology of Vytorin in my posts and explained the purpose and short comings of the Enhance study in terms of the subjects used, and the fact that its results warrant further study.

    The Enhance study reveals that further investigation must be done.

    Now how does that make me full of my self or full of crap?

    When you cant out argue a well educated chap, you attack him. You are so very funny Subscriber.

    Weak weak bowling man pitch up de ball and stop bowling long hops man.

  22. Rachelle Pringall Avatar
    Rachelle Pringall

    Know what I think Subscriber, it seems that you are the Lipitor representative in Barbados, and that Vytorin licking up your sales. So you come in this forum under the pretense that you are providing information for Bajans who might be taking the drug.

    I have also read the articles online, and in none of the several articles I found do I read that Vytorin failed in tests to show that it is any good and patients are being told to stick with statins like Lipitor. No where. Please produce the articles or links to this effect.
    Subscriber you deserve the whipping you got from GP.

    Surely Barbadians are taking Vytorin, and assuredly such folk are happy to get accurate information about the medication they are taking.
    I am pleased to see that a fellow Barbadian could explain the issues about the drug, and that we don’t have to depend on the words of the “creme de la creme of the Medical cultures in the USA.”:.

    GP certainly made the articles I read clearer to me.

    Here is what I found about his favorite word efficacy!

    The ability of a drug to produce a desired therapeutic effect is called efficacy. When we are speaking of efficacy we are discussing the ability to get the job done- the ability to provide the desired therapeutic effect. Efficacy is the degree to which a drug is able to induce maximal effects.

    Efficacy is dependent on the number of drug-receptor complexes formed, and the efficiency of coupling of receptor activation to cellular responses.
    The property of efficacy has legal as well as therapeutic importance. The 1962 Kefauver-Harris amendments to the Federal Food, Drug, and Cosmetics Act require proof of efficacy of a drug before it can be marketed. Before that time only evidence of safety was needed

    This means Mr Subscriber a ka Lipitor rep that under the Kefauver-Harris amendments to the Federal Food, Drug, and Cosmetics Act, proof of efficacy for Vytorin had to be provided for it to be marketed. Don’t you think? So this proves that the drug is a bone fide drug. It just does not reduce plaque build up as the statins do. QED

  23. Rachelle Pringall Avatar
    Rachelle Pringall

    Know what I think Subscriber, it seems that you are the Lipitor representative in Barbados, and that Vytorin licking up your sales. So you come in this forum under the pretense that you are providing information for Bajans who might be taking the drug.

    I have also read the articles online, and in none of the several articles I found do I read that Vytorin failed in tests to show that it is any good and patients are being told to stick with statins like Lipitor. No where. Please produce the articles or links to this effect.
    Subscriber you deserve the whipping you got from GP.

    Surely Barbadians are taking Vytorin, and assuredly such folk are happy to get accurate information about the medication they are taking.
    I am pleased to see that a fellow Barbadian could explain the issues about the drug, and that we don’t have to depend on the words of the “creme de la creme of the Medical cultures in the USA.”:.

    GP certainly made the articles I read clearer to me.

    Here is what I found about his favorite word efficacy!

    The ability of a drug to produce a desired therapeutic effect is called efficacy. When we are speaking of efficacy we are discussing the ability to get the job done- the ability to provide the desired therapeutic effect. Efficacy is the degree to which a drug is able to induce maximal effects.

    Efficacy is dependent on the number of drug-receptor complexes formed, and the efficiency of coupling of receptor activation to cellular responses.
    The property of efficacy has legal as well as therapeutic importance. The 1962 Kefauver-Harris amendments to the Federal Food, Drug, and Cosmetics Act require proof of efficacy of a drug before it can be marketed. Before that time only evidence of safety was needed

    This means Mr Subscriber a ka Lipitor rep that under the Kefauver-Harris amendments to the Federal Food, Drug, and Cosmetics Act, proof of efficacy for Vytorin had to be provided for it to be marketed. Don’t you think? So this proves that the drug is a bone fide drug. It just does not reduce plaque build up as the statins do. QED

  24. David Avatar
    David

    QEH patients get iodine after mix-up
    Published on: 4/6/08.

    AFTER SEVERAL WEEKS of waiting in pain, the dozens of Queen Elizabeth Hospital (QEH) patients needing radioactive iodine for treatment of their cancer condition, have finally received it.

    The story was first highlighted in the SUNDAY SUN of March 23, 2008.

    The QEH had said then that supplies of the medication were scheduled to reach the hospital on Tuesday, March 25. However, they arrived in Barbados three days later on the afternoon of Friday, March 28. The patients started receiving treatment last Monday (March 31).

    The QEH explained the delay came about when the airline refused to accept the supplies due to what has been described as “a mix up”.

    “This resulted in the last minute cancellation,” said the QEH’s communication specialist, Mike Maycock. (SP)

    Source: Nation

    Here are some questions which are being asked by members of the BU family which were not answerable from the Nation report.

    (1) why did the hospital allow the iodine supply to reach such a low level in the first place which dictated the critical time frame for getting a re-supply that did not allow for “intransit” unforeseen circumstances and more importantly
    (2) How can an airline “Refuse” to ship the iodine because of a “mix-up” Airlines have to be held accountable for why they would have “refused” to ship this critical life saving medicine and were the truth known there was no “mix-up, it is more likely that this is a “cover up by hospital administrators of their ongoing incompetence!

    It is amazing that Bajans will speak-out about hair styles, who is sleeping with who, political trivia and other matters which in our view rank lower to matters of how we deal with our health. Yet we don’t hold our leaders accountable? Yes indeed, we do agree with the email we got this morning.

  25. Georgie Porgie Avatar
    Georgie Porgie

    Cholesterol is made in our bodies from a substance called Acetyl CoA.

    Acetyl CoA is itself a central compound of the body’s metabolism.

    It is made when we break down the fatty acids obtained from digestion of the fat we eat in our food.

    It is made too from certain amino acids in the protein we take in our food.

    It is also made from the carbohydrates in our food.

    Acetyl-CoA can also be derived from the alcohol we consume.

    The first step in making cholesterol in the body involves two molecules of acetyl-CoA condensing to form acetoacetyl-CoA. That is 2 Acetyl CoA’s join up or hold hands if you please. This reaction requires a catalyst called an enzyme to make the reaction occur.

    The next step in making cholesterol in the body involves the acetoacetyl-CoA made in the first step condensing or joining up with a next (i.e a third) acetyl-CoA. . This reaction also requires a catalyst called an enzyme to make the reaction occur.

    So as a result of this threesome if you please, we have a substance we call HMG-CoA for short.

    Next HMG-CoA is converted to a substance called mevalonate in a two step reaction. And yes you guessed correctly. This reaction also requires a catalyst called an enzyme to make the reaction occur. Except that this reaction (catalyzed by the enzyme HMG-CoA reductase) is considered to catalyze the rate-limiting step in the pathway of cholesterol synthesis and is the site of action of the most effective class of cholesterol-lowering drugs, the HMG-CoA reductase inhibitors (known as the statins)

    The drugs like Zocor and Lipitor block the further synthesis of cholesterol by all the several steps that follow by blocking the making of mevalonate. If the body does not make mevalonate, it can not make cholesterol.

    This is the mechanism of action of the drugs we call statins. Statins work by mimicking or pretending to be mevalonate, and thereby blocking the activity of the enzyme HMG-CoA reductase.

    The drug Vytorin contains as one of its components a statin (Simvastin), and so it is able to lower cholesterol levels by limiting the synthesis of cholesterol in the body.

    Does this mean that a person who takes statins, have no cholesterol in their blood stream?
    Of course not!

    Why is this, you may ask? The answer is because we take it in our diets with the fats we eat. Thats what the Vytorin ad says. We get cholesterol from the franks we eat , and from daddy Frank!

    So the Pharmaceutical companies made a drug (Ezetimibe) that blocks the absorption of cholesterol from the gut into the blood.

    So now we have statins that block the MAKING of cholesterol IN the body. And we have Ezetimibe which blocks the ABSORPTION of cholesterol INTO the body.

    So the manufacturers of these two drugs decide to get together and make a product that would as we say hit two birds with one stone. That is one drug formulation would now block the MAKING of cholesterol IN the body as well as . block the ABSORPTION of cholesterol INTO the body. The manufacturers were aiming for the synergistic effect of 1+1= 2. Hence Vytorin which is Ezetimibe and Simvastin.

    And as far as lowering the HDL cholesterol in the body and achieving an increase in the lowering of HDL cholesterol in the body, Vytorin was shown in clinical trials in 2004 to do as designed. Hence its approval and subsequent success on the market.

    So what is the issue?

    The enhance study showed that the combination drug Vytorin did not decrease the level of plaque build up in the arteries as was expected.

    Though 1+1= 2. was achieved for lowering of HDL cholesterol in the body, 1+1= 2. was NOT achieved for decreasing the level of plaque build up in the arteries as was expected

    Can we then say that Vytorin is useless, or that it does not work? I dont think so.

    If my son passes the common entrance with high marks, gets all A’s in his A levels but then only gets a lower second pass at Cave Hill, shall we conclude that he is a dunce because he didn’t get first class honours?

    I rest my case.

    I hope this post further clarifies the non existent controversy created by the press and reckless opinion.

  26. Straight talk Avatar
    Straight talk

    Thanks for the elucidation, GP.

    What is the major cause of plaque formation, and how can we prevent this potential killer?

  27. Pat Avatar
    Pat

    Georgie Porgie:

    Please, one does not have to be a medical practitioner to read and understand scientific papers. I am not, nor am I a scientist, but I have acquired a good knowledge of S&T. My journals of preference were Science, Nature, Technovation, and those infernal AAAS journals with which I was inundated. They came one every week, so that I could only follow one or two threads of research if I wanted to accomplish any work. To cut down on the extensive reading I would have my students prepare precis of some of the articles I was interested in. If after reading them the content was not clear, then I would read the article myself. (No, I am not a professor, I hired university students on a co-op program to assist me with research for my projects.)

  28. @loss Avatar
    @loss

    Georgie Porgie’s explanation about the production of cholesterol and the pharmacology of relevant drugs was not only interesting but quite clear and to the point (and I failed chemistry in school!) Thanks GP.

    What would be of futher interest and use are answers to the question: can plaque build up be reversed?

  29. Georgie Porgie Avatar
    Georgie Porgie

    Oh you are so very correct dear Pat.

    Could you or your students read the chapter on kidney diseases in Robbins text book of Pathology and interpret it for me, and send me a precis thereof.

  30. Georgie Porgie Avatar
    Georgie Porgie

    What is the major causes of plaque formation, and how can we prevent this potential killer?
    ==============================
    Recent evidence suggests that bacteria and viruses that cause such common ailments as pneumonia, gum disease, and ulcers could be at least contributing factors in the formation of the fatty arterial deposits, or plaques, that lead to heart attacks and many strokes, perhaps by triggering inflammation. So far, the evidence is largely circumstantial, but further research is now on to determine the exact mechanism by which these infections might be related to heart disease and whether antibiotics could serve as a preventive measure or treatment

    Please see if the links below help.

    These sites handles the above questions fairly simply, I think. More later
    http://www.sensible-alternative.com.au/sensnews18.doc

    http://niazi.com/Omega/plaque.htm

    http://www.hdi-pulsewave.com/physicians/cvhealth.htm

    If they dont let me know, and I will try to make it easier in the next two weeks………

    OR

    I am sure that Pat and her research assistants will help you out with a precis or two.

  31. David Avatar
    David

    GP please email us the document!

    David

    We have always heard that if you want to thin the blood take an aspirin or drink brandy! So what about this Chinese made drug heparin? Is it on the shelves in Barbados?

    FDA Raises Estimate of Deaths Linked to Blood Thinner

    By Marc Kaufman
    Washington Post Staff Writer
    Wednesday, April 9, 2008; Page A03

    The Food and Drug Administration yesterday raised from 19 to 62 its estimate of the number of people who may have died after having allergic reactions to contaminated Chinese-produced batches of the blood thinner heparin.

    The new statistics on fatalities, which the FDA had promised for weeks, were posted on the agency’s Web site.

    The posting said that the reports of allergic reactions or low blood pressure after the administration of heparin do not mean the drug was the cause of death “in all cases.” But the agency provided comparison statistics showing that in 2006, three people were reported to have died following allergic reactions to heparin.

    In addition, FDA’s month-by-month count of adverse-event reports involving heparin showed that 47 of the 62 deaths associated with allergic reactions occurred from November through February.

    The FDA said it had received reports of 103 people who died after receiving heparin last year, 62 of whom experienced an allergic reaction or a plunge in blood pressure. The others showed no signs of allergic reaction.

    Erin Gardiner, spokeswoman for Baxter International, which distributed the contaminated heparin, said last night that the company had received reports of 38 deaths associated with the drug, but its officials maintain that four of those were the result of unexplained allergic reactions. The rest of the reported deaths, Gardiner said, were not associated with Baxter’s heparin, were probably caused by other illnesses or conditions, or were based on information too cursory to be proved one way or the other.

    The increase in reports of suspected heparin fatalities does not mean that people are still being harmed by the drug. The contaminated Baxter heparin was taken off the market several months ago, but earlier cases are still being reported and investigated.

    Heparin, which is made from a compound found in pig intestines, has been widely used for decades during surgery and kidney dialysis.

    FDA officials have said that some Chinese-produced heparin and active ingredients used to make it were contaminated with a substance that chemically resembles heparin but was different enough to have caused the sudden spike in allergic reactions.

    In previous statements, the agency said it did not know whether the cheaper contaminant — which may have come from pig cartilage — was deliberately added to the crude heparin or was the result of a production problem.

    China is now the world’s largest producer of the raw ingredients in heparin. The contaminated batches of the drug have increased concerns among lawmakers and the public about the globalization of drug-manufacturing in lightly regulated nations. In response to criticism that it was not properly overseeing Chinese companies that make drugs for American patients, the FDA recently announced that it would soon open its first office there.

    It took sophisticated, never-before-used tests to detect the contaminated heparin, and identifying the contaminant as a form of chondroitin sulfate took additional weeks of laboratory work.

  32. Georgie Porgie Avatar
    Georgie Porgie

    We have always heard that if you want to thin the blood take an aspirin or drink brandy! So what about this Chinese made drug heparin? Is it on the shelves in Barbados?
    =================================
    The drug heparin is classified as an anticoagulant, i.e a drug that decreases the formation of fibrin clots and limits their expansion. Two major types of anticoagulants are available: heparin and related products, which must be given by injection, and the orally active coumarin derivatives (eg, warfarin also used as rat poison).

    Because it acts on preformed blood components, heparin provides anticoagulation immediately after administration.

    Heparin limits the expansion of thrombi by preventing fibrin formation and has the advantage of speedy onset of action, which is rapidly terminated on suspension of therapy.

    Because of its rapid effect, heparin is used when anticoagulation is needed immediately (eg, when starting therapy).

    Clinically, heparin is used prophylactically to prevent postoperative venous thrombosis in patients undergoing elective surgery (for example, hip replacement) and those in the acute phase of myocardial infarction.

    Heparin is used in combination with thrombolytics for revascularization and in combination with glycoprotein Ilb/IIIa inhibitors during angioplasty and placement of coronary stents.

    Heparin has been the major antithrombotic drug for prevention and the treatment of deep-vein thrombosis and pulmonary embolism. The incidence of recurrent thromboembolic episodes is also decreased.

    Coronary artery rethrombosis after thrombolytic treatment is reduced with heparin. Heparin is also used in extracorporeal devices (for example, dialysis machines) to prevent thrombosis.

    Heparin is a very useful drug and has been used in Barbados (and all over the world ) for many years.

    So what is the current controversy?

    Heparin is not a Chinese drug per se. Like most things, these days it can be obtained from China more cheaply. The problem seems to be that the Chinese were careless with the batch that has caused the trouble in the USA.

    Because heparin preparations are obtained from animal sources it may therefore, be antigenic, and cause hypersensitivity reactions. Possible adverse reactions include chills, fever, urticaria, or anaphylactic shock.

    On the other hand, aspirin, inter alia, is classified as an antiplatelet drug. It is used for a different purpose than heparin.

    Anticlotting drugs are used primarily for treatment of arterial disease that inhibit the clotting function of platelets by preventing platelet activation and adhesion. Platelet aggregation plays a central role in the clotting process and is especially important in clots that form in the arterial circulation(coronary and cerebral artery occlusion).

    Platelets are believed to be especially important in coronary and cerebral artery occlusion. Consequently antiplatelet drugs are used primarily for treatment of arterial disease.

    Aspirin in low doses is used to prevent MI and recurrence, and is prophylaxis in atrial arrhythmias and TIAs (mini strokes).

    Aspirin is currently employed in the prophylactic treatment of transient cerebral ischemia (transient ischemic attacks TIAs), ischemic stroke (major strokes) , and other thrombotic events, to reduce the incidence of recurrent myocardial infarction, and to decrease mortality in pre and post-myocardial infarct patients.

    Aspirin is used to prevent further myocardial infarcts ( heart attacks) in individuals who have had 1 or more myocardial infarcts and may also reduce the incidence of first infarcts.

  33. Anton Avatar
    Anton

    Nova Scotia & it’s collegues in Saudi Arabia & the USA may know more about this as They invested in 1`993-Pharmacuticals & Medical Diagnostics.

    Quote from NS MP to unelected “Associate”- “sounding too incredible to be true, noone will believe it.” APPOINTED, Federal Health Minister/96, having (illegaly lobbied Fed. Gov. prior to being elected for Middle-East Bioscoence firm(s)).the plan was to use persons (Families), in the Lunenburg County area of NS, who NEEDED to get their Medications through NS-Community Services in unethical-probable illegal medical research, without their knowledge or consent.
    Dingwall quote-“Doctors at hospital will appear to be natural causes. Sounding too incredible to be true, noone will believe it.” They, then went on to direct Nova Scotia to make their neccessary changed to Nova Scotia’s Legal Aid mandate-legislation, to ensure the victims would be left Totally Defenseless.
    He said, justified what They were doing as “THEY ARE A DRAG ON THE SYSTEM ANYWAY.” David Dingwall fax to Bob Douglas in Mahone Bay, Lunenburg County, Nova Scotia, CANADA.

    To get a descriptive picture of Nova Scotia, Canada, read * THE BAG MAN. A Life In Nova Scotia Politics *- author, Donald F. Ripley. Former NS FINANCE MINISTER during the MULRONEY-BUCHANAN regime.

    ON THE TAKE. Greed, Crime and Corruption during the (Brian) MULRONEY years.
    Author -Stevie Cameron. Reknown Investigative Reporter-Author.

  34. Joeseph Avatar
    Joeseph

    Private Islands Real Estate, MAHONE BAY as there are Global Private Islands realtors. Another out of NOVA SCOTIA and am office in Germany We’ve read, is Farhad Vladi.

    Have you read EUGENICS in Nova Scotia. NOVA SCOTIA, CANADA with it’s DALHOUSIE UNIVERSITY MEDICAL RESEARCH, The Nova Scotia government and it’s Nova Scotia hospital somehow manage to fly under the radar screen in regard to It’s EUGENICS Research.
    Yes, the dejavue is easily recognizable to the 1993 research agenda. Nova Scotia and yes, it is corrupt from The Top, down. MULRONEY vile, sell the soul to the devil, the arab monies arranged the …sigh…’Leader of The Party with The Elections.

    Mulroney and Nova Scotia/Germany Associates, close moneies associations to the saudi’s took on a new meaning in 2001 and now with Nova Scotia’s offshore oil projects and wells. Is it your opinion that makes them Traitors to their country? So far, it is mine.

  35. Georgie Porgie Avatar
    Georgie Porgie

    Lotrel Cuts Heart, Stroke, Death Risk
    Combination Blood-Pressure Tablet Beats Older Combo Drug in Trials
    By Charlene Laino
    WebMD Medical News
    Reviewed by Louise Chang, MD
    March 31, 2008 (Chicago) — A tablet that contains two different types of blood-pressure-lowering medications cuts the risk of heart attack, stroke, or death by one-fifth, when compared with an older combination drug, researchers report.
    The drug, Lotrel, proved so effective at preventing cardiovascular disease and deaths that the study was halted early so all patients could be offered it.
    “It’s a clear win,” says study researcher Kenneth Jamerson, MD, professor of internal medicine at the University of Michigan Medical School.
    The study compared two combination pills, both of which contain the angiotensin-converting enzyme (ACE) inhibitor Lotensin. Lotrel combines Lotensin and the calcium channel Norvasc. The other pill contained Lotensin and a diuretic called hydrochlorothiazide.
    1 in 3 Americans Have High Blood Pressure
    People whose systolic numbers (that’s the top number in your blood pressure reading) are 140 or higher or whose diastolic numbers (the bottom number) are 90 or higher are considered to have high blood pressure. One in three people, or more than 73 million Americans, fit the bill.
    Often treatment begins with diet and exercise. If the blood pressure goal is not achieved, diuretics are commonly prescribed as the initial therapy for patients, either alone or in combination with another class of blood pressure-lowering medication.
    Jamerson says the findings “should modify future guidelines for the treatment of hypertension,” both in terms of starting with a one-drug strategy in some patients and starting with diuretics.
    He notes that many patients find it more convenient to take a single-tablet combination of drugs rather than a handful, or even a couple, of different pills.
    Combos Lowered Blood Pressure
    The new study involved more than 11,000 people over 60 who had high blood pressure and other cardiovascular disease risk factors, such as obesity or diabetes.
    Only 37% of participants had adequate blood pressure control at the start of the study.
    By 36 months later, the average blood pressure in 80% of patients in both groups was less than 140 over 90, which is “excellent,” Jamerson says.
    Importantly, patients taking Lotrel were 20% less likely to die from cardiovascular disease, have a heart attack or stroke, be hospitalized for the chest pain of angina, or need a procedure to open blocked heart arteries.
    American Heart Association President Dan Jones, MD, dean of the University of Mississippi School of Medicine in Jackson, tells WebMD that he hopes the findings will propel more “people to think about starting with combination therapy” to lower blood pressure.
    Treatment with a single drug often isn’t effective, he explains.
    But Jones says more study is needed before he would conclude that a combination of an ACE inhibitor and a calcium channel blocker is the way to go.
    “If you look at the totality of all the trials that have been done, the results are mixed. And right now the state of knowledge is that it is lowering blood pressure, not how you get there, that’s the more important thing,” Jones says.
    “As a result, we should focus on whatever combination gets you to your target blood pressure without causing adverse events,” Jones says. That could mean a combination of any of the five classes of drugs known to lower blood pressure; diuretics, ACE inhibitors, calcium channel blockers, beta-blockers, and angiotensin receptor blockers.

    ==============================
    Note that this study used 11,000 patients a much more significant sample than the 720 we discussed for the Enhance study lat weekend.

    Note too that these patients were all more suitable for this study- they more the normal run of the mill hypertensive patient.

    Note also though the researchers claim success that they are still planning to do further studies to confirm their findings.

  36. David Avatar
    David

    MRI technology is a key requirement in the medical fraternity to quickly diagnose problems of the human anatomy. It appears to be a technology which fits into modern day lifestyle of convenience. BU was pleased to learn of improvements in the MRI technology and wondered when it would arrive in Barbados to help our doctors here to be equally as effective as those on the outside.

  37. Straight talk Avatar
    Straight talk

    David,

    I believe it has arrived in Belleville, just not made it down the road to QEH.

  38. QEH Avatar
    QEH

    ST how will the masses benefit if it remains private?

  39. Georgie Porgie Avatar
    Georgie Porgie

    You pay for it in Belleville. Thats free enterprise at work!

    Why cant the doctors who are Ministers Of Health not get the same for the masses?

  40. BLP Blog Avatar
    BLP Blog

    The bickering about the QEH continues.

    A butcher, a baker…….

    THE GOVERNMENT finally brought down its first bill to the house on Tuesday. Four months in gestation, it was obviously a casualty of induced labour. The Minister of Health has stamped (or is it stomped) his authority on the composition of the Queen Elizabeth Hospital (QEH) board through the Queen Elizabeth Hospital Amendment Act.

    Our hospital is now to be managed by an accountant, an engineer, a finance manager, a human resources manager, an industrial relations practitioner, and a trained IT person, a lawyer, a doctor, a nurse, a paramedic and someone trained in management operations (whatever that means). The Permanent Secretary, Ministry of Health and the Chief Medical Officer are to be ex-officio members of the new board.

    The minister will now appoint all 13 members of the board and none of them can be members of staff of the QEH. The very people who are responsible for the successful operation of the hospital are no longer good enough to have a say on the board. They will no longer be allowed to make any input on policy at board level. They will no longer be allowed to participate in the decision-making process. Their experience and institutional memories will no longer be used to guide the board. Not for them any contribution to the Government’s “Rescue Plan”.

    This backward policy decision by the goodly doctor is both reprehensible and insulting to the professionals at the Queen Elizabeth Hospital. But it is all the more so, given the Democratic Labour Party’s (DLP) promise in its manifesto to allow “for real participatory democracy in Barbados where public policy is not imposed from the top . . .”. If the minister did not read that section, we want him to read this one from a few paragraphs earlier: ” . . . Too many Barbadians perceive voting as a waste of time since many parliamentarians have made promises during the election campaigns, which they have not delivered.” In fact, it should be required reading for the entire DLP Cabinet.

    What is even more amazing is that although QEH is a teaching hospital and part of the Cave Hill Campus Faculty of Medicine, the representatives of the university have been unceremoniously tossed off the board. The baby has been thrown out with the bath water.

    Even if the minister did not want to keep the representatives from the Barbados Association of Medical Practitioners, or the Barbados Registered Nurses’ Association, or the Chief of Medical Staff, or the Director of Nursing, we can find no logic in his dispensing with the dean of the School of Clinical Medicine and Research.

    Even if he saw no value in having representation from the Barbados Association of Retired Persons, or the Christian Council, the Congress of Trade Unions and Staff Associations of Barbados, the Private Sector Agency or the nominee of the principal of the Cave Hill Campus of the University of the West Indies, how does he justify a policy that will now cause the focus to be on personalities instead of the wider groups, which they previously represented?

    Is his idea of participatory democracy a shopping list of various skill sets? In this regard, we cannot help but recall a verse from our childhood:

    Rub-a-dub-dub three men in a tub, And how do you think they got there?

    A butcher, a baker a candlestick maker � They all jumped out of a rotten potato!

    ‘Twas enough to make a fish stare.

    The minister’s odd thought process aside, we wish the men and women that he appoints to the board God’s blessing in their endeavours.

  41. Ding Dong Bell Avatar
    Ding Dong Bell

    The BLP just do not understand.

    The doctor who is the minister of Health does not know what he is doing. He does not have a clue!

  42. Gabriel the Horn Blower Avatar
    Gabriel the Horn Blower

    The present Minister of Health achieved a major coup when he “discovered” a room that can be utilised by the Accident and Emergency division. I now sleep better at night.

  43. Georgie Porgie Avatar
    Georgie Porgie

    Could you illucidate and illuminate dear Sir?

    I have promised not to say too much about the inability of the current government to deal with issues of health in Barbados, on the advice of Sam Gangree a few months ago, whem I attempted to reveal by proposals for the siting of our polyclinics/emergency centers.

    Even the prominent BU bloggers dont seem interested in such issues. Folk in Barbados tend only to comment on health issues when it affects them personally or thier families.

  44. Dr POWA POWA Avatar
    Dr POWA POWA

    The BLP’s reference to Rub-a-dub-dub three men in a tub is clearly a reasonable and accurate assessment of the DLP’s approach to health care in Barbados. Unfortunately, many will fail to respond to the BLP’s opinion because their recent failures seems to indicate that they are a pot calling the kettle black! However, the article is well written and reveals a lack of common sense by the minister. The minister’s idea of participatory democracy as a shopping list of various skill sets is definitely puerile. Truly it is enough to make a fish stare.

    However, at the same time THE TRUTH IS THE TRUTH! Prior to the elections, the current Minister of Health was braying that he wanted POWA POWA. In the process, it seems that he destroyed the very few brain cells that he had with the noise he made.

    That the QEH is now to be managed by an accountant, an engineer, a finance manager, a human resources manager, an industrial relations practitioner, and a trained IT person, a lawyer, a doctor, a nurse, a paramedic and someone trained in management operations, with the Permanent Secretary, Ministry of Health and the Chief Medical Officer as ex-officio members indicates the lack of common sense in the leadership of the Ministry of Health.

    The Chief Medical Officer is a relative junior with little creative ability. The Permanent Secretary knows nothing about Health or Health Systems. Of the others in the list, one hopes that the doctor and the nurse selected might have an inkling, but do they know about running a hospital? Perhaps the most this motley bunch could do, is offer their advice on the workings of the departments of the hospital that they supervise. In which case then the members of the selected bunch can not then be just any doctor or nurse or engineer or finance manager. They would have to be leaders in their respective departments.

    Unlike the BLP, I can see no value in having representation from the Barbados Association of Retired Persons, or the Christian Council, the Congress of Trade Unions and Staff Associations of Barbados, the Private Sector Agency or the nominee of the principal of the Cave Hill Campus of the University of the West Indies, unless these representatives have some great grasp of health issues.

    However, we must agree with the BLP that since the QEH is a teaching hospital of the UWI, the representatives of the of the Cave Hill Campus Faculty of Medicine university must be included, along with representatives from the Barbados Association of Medical Practitioners, the Barbados Registered Nurses’ Association, the Chief of Medical Staff, the Director of Nursing, and the dean of the School of Clinical Medicine and Research.

    It is asinine and dictatorial for the minister to appoint all 13 members of the board ; none of whom can be members of staff of the QEH. How can those responsible for the successful operation of the hospital no longer have an input on policy at board level, or participate in the decision-making process. That the minister can not see that their experience is of value is not only both reprehensible and insulting to the professionals at the Queen Elizabeth Hospital, but reveals that the Minister has less sense than little boys in the village, when starting a liitle cricket “match” and saying “I run you captain- first pick!”

    God help Barbados! Our Healthcare is completely in the hands of an ass of lowly brayyyyyyyyyyyyyyn! Yes! He brays but has little brain!

  45. David Avatar
    David

    Some interesting news coming out of cancer research:

    developments in the war on cancer
    Posted: 03:12 PM ET

    By Miriam Falco
    CNN Medical Managing Editor

    There’s been a lot of news about cancer this week. Specifically, one of the deadliest, brain cancer. Sen. Ted Kennedy is fighting it. Fashion icon Yves Saint Laurent died after battling it for a year. This news overshadowed some important advances in cancer research presented at the largest cancer conference in the world. Every year physicians, researchers, pharmaceutical companies and journalists gather for the annual meeting of the American Society of Clinical Oncologists (ASCO). This year more than 33,000 people attended the 44th annual conference. There’s always an expectation of a big, blockbuster report that will make a huge impact on cancer patients.

    This year researchers presented more than 5,000 studies — some small or preliminary, others significantly advancing patient care. ASCO president and breast cancer specialist Dr. Nancy Davidson points out that, “Today, there are more than 10 million cancer survivors (in the United States) compared to 3 million in the 1970s.”

    Here’s a brief round-up (in no particular order) of some of the findings that caught my eye at this year’s conference:

    – A drug approved for osteoporosis called Zometa not only helped reduce bone loss in premenopausal breast cancer survivors, it also helped reduce the risk of relapse by a third. It’s too early to say whether these women will live longer, but researchers saw these benefits without going on chemotherapy.

    – Doctors can use a test that costs about $100 to determine whether the drug Erbitux will help prevent the spread of colon cancer. Researchers found Erbitiux did not work with tumor cells that have a mutated form of a certain protein. However, if the patient’s tumor had a normal version of the protein, taking Erbitux plus regular chemotherapy reduced his or her risk of recurring cancer by 32 percent.

    This is important because it helps doctors determine who will benefit from this drug. It saves patients from wasting time on a drug that won’t work for them, avoids their dealing with any side effects that can occur and saves a lot of money because this relative new drug is very expensive ($8,000 for 4 dosages; patients usually need 12).

    – Researchers also found that adding this same colon cancer drug Erbitux to standard chemotherapy in non-small cell lung cancer patients, compared with those on only standard chemotherapy extends survival by a month. One month more may not seem like a lot, and the researchers themselves call it “a small step forward that opens up new avenues in research.” But it shows that this drug, which targets a specific characteristic of the tumor, has a survival benefit. That’s important to patients and their families and represents another step forward in treating the No. 1 cancer killer in the world.

    This is not a comprehensive synopsis of the meeting, and several experts I spoke with wouldn’t call these “home run” findings – more like somewhere between a single and a double (their analogy, not mine). But researchers are learning more about what’s going on inside a tumor and finding ways to stop cancer from spreading. That’s good news for the more than 1.4 million Americans who will develop cancer this year. But fighting cancer depends on having the resources to conduct more research. Another theme of this conference was lack of research dollars. Davidson, the oncology group’s president, says National Institutes of Health funding declined by $500 million since 2003. The National Cancer Institute’s director Dr. John Niederhuber told reporters, “We’re supporting fewer clinical trials.”

    That’s because the NIH budget has been flat since 2004 – add in inflation – and the actual money is less. Less money means less research. Do you think the U.S. government needs to spend more on cancer research? If so, at what cost to other health initiatives?

    For more information on these studies and information on cancer, you can go to ASCO’s newly launched website http://www.cancer.net. The American Cancer Society, at http://www.cancer.org, also has a lot helpful information for you.

    Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

  46. David Avatar
    David

    Diabetes is a scourge in Barbados. It seems the young and the old are equally afflicted. It leads to amputations galore!

    Vitamin D may protect against diabetes
    Submitted by WWAY on 6 June 2008 –

    Some research suggests that vitamin D may help protect against cancer and a new study finds it may protect against diabetes as well.

    Exposure to the sun’s rays triggers vitamin D synthesis in the skin, so people who live in sunny parts of the world tend to have high levels of vitamin D.

    Among the many health benefits of vitamin D is improved immune system function, so doctors wondered if higher sun exposure could help protect against immune system disease, such as type 1 diabetes.

    Researchers from the University of California at San Diego studied the relationship between countries’ proximity to the equator and their rate of type 1 diabetes.

    They found that countries which didn’t receive a lot of sun, such as Canada, Norway and Sweden, had higher rates of the disease than sunny countries such as Cuba, Barbados, and the Dominican Republic.

    The relationship isn’t perfect, however. Poland had a lower rate of type 1 diabetes than the much sunnier Puerto Rico.

    Other factors such as genetics and lifestyle probably play a role.

    Doctors say it’s too soon to know if sun exposure can affect an individual’s risk for diabetes, but that vitamin D is important for healthy bones, kidneys, and immune system regulation.

    They recommend people get 10 to 15 minutes per day of sun to maintain adequate levels of this important vitamin.

  47. David Avatar
    David

    Barbados Consumers Watch goes to work.

  48. David Avatar
    David

    Read what Bajan Reporter has to say on this interesting development.

    NONOXYNOL-9 CONTRACEPTIVES AND SPERMICIDAL PRODUCTS CAN BURN YOUR BACKSIDE, NOT FOR TRUNKING
    Labels: adult, Barbados, death, health, medical, sex

    Barbados’ Ministry of Health is discouraging the use of all over-the-counter (OTC) vaginal contraceptive and spermicidal products containing the chemical ingredient nonoxynol-9 (N-9).

    Read full article

  49. Cell phones harmful? Avatar
    Cell phones harmful?

    Thought this may be of interest to readers of BU :

    http://news.bbc.co.uk/2/hi/health/7523109.stm

  50. David Avatar
    David

    Any truth to the report that as at 5PM today no private or public ambulances were available to answer distress calls?

1 2 3 … 8
Newer Comments

The blogmaster invites you to join the discussion.

Trending