Just a reminder that new posts are at the new site, and comments here are infrequently moderated. The new stuff:
Shameless Self-Promotion - OBOS blog post picked up in a midwifery newsletter
Do You Have Your Period? - One high school's inappropriate questioning of teen girls
On PharmaLot, this post adds some detail to previous allegations (which we most recently discussed here), that top executives, now including the top-most executive at GlaxoSmithKline tried to silence an academic physician who had doubts about the safety of rosiglitazone (Avandia). This is another reminder of the lack of transparency of the pseudo-market in pharmaceuticals. As we have said before, of course, intimidating people who blow the whistle about drug safety concerns is bad not only for the whistle-blowers, but for patients and doctors whose decisions about which treatments to give ought to be based on critical review of the best possible clinical evidence, not evidence that is filtered by secrecy and intimidation to only reflect vested interests of the makers of the treatments.
Introduction: How to Make the Best Clinical Decisions?
Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only studies done are of individual treatments to placebos, and most such studies are done in patients unlike those seen in daily practice, physicians are left juggling oranges, tomatoes, and carburetors.
Comparative effectiveness studies are simply studies that compare some of the plausible treatments that could be used for patients with particular problems. As a physician, I welcome such studies, because they may provide very useful information that could help me select the optimal treatments for individual patients.
Because I believe that comparative effectiveness studies could be very useful to improve patient care, it upsets me to see this particular kind of clinical study get caught in political, ideological, and economic battles.
The American Heart Association has provided (via Forbes) the following list of possible risks posed by fad diets.
Nutritional deficiencies caused by a lack of a balanced diet. Lack of physical activity from emphasis on diet only can increase the risk of heart disease. Lack of variety in foods can cause boredom and frustration, and make it difficult to maintain the diet for more than a brief period. Severe restrictions on the foods you can eat may make it difficult to establish and maintain a healthy diet in the future. Many quick weight-loss diets are based on unfounded claims that may do more harm than good.
People try fad diets because they want to lose weight fast but that isn't a healthy way to lose weight. The American Heart Association says the right way to diet and lose weight is "slowly, over time, and while eating a balanced diet with plenty of healthy foods." That's not what people desperate to lose weight want to hear but it is better for your heart and overall health if you avoid risky dieting.
Reuters reports that matematical analysis has confirmed that the deadly bird flu virus was spread from human to human in Indonesia in 2006.
A mathematical analysis has confirmed that H5N1 avian influenza spread from person to person in Indonesia in April, U.S. researchers reported on Tuesday.They said they had developed a tool to run quick tests on disease outbreaks to see if dangerous epidemics or pandemics may be developing.
WebMD reports on a possible link between microwaved popcorn and lung disease. The potential problem is a chemical in the popcorn called diacetyl that may be very dangerous when inhaled. Lung problems have been diagnosed in workers at factories where microwave popcorn is made. This particular article also discusses a case involving a non-worker who fell ill with lung problems. This person ate two or more bags of microwaved popcorn a day.
It's a rare disease, first seen in 1985 in workers in food-flavor factories. In 2002, the disease was seen in workers making microwave popcorn -- in particular, those exposed to a buttery-tasting chemical called diacetyl. There have been many other reports since then, with at least three deaths and many patients awaiting lung transplants.But Rose's patient had never been exposed to food-flavoring fumes. His only exposure was to the two or more bags of microwave popcorn he consumed every day.
ABC reports that microchips already approved for human and pet use have induced tumors in lab mice and rats. The FDA apparently decided the public didn't need this information at the time they approved the microchips.
Those chips are now being implanted in some people, especially Alzheimer's patients, and encoded with their medical records. The Food and Drug Administration called the microchip one of 2005's top innovative technologies.The microchips have been implanted in hundreds of people like Ida Frankel, who has Alzheimer's disease. If she gets lost and ends up in a hospital, doctors can scan her arm and get all of her medical records.
An important new article in PLoS Medicine expanded thinking about the involvement of pharmaceutical companies (and possibly other health care corporations) in the shaping of clinical research. [Sismondo S. Ghost management: how much of the medical literature is shaped behind the scenes by industry? PLoS Med 4(9): e286 doi:10.1371/journal.pmed.0040286]
Sismondo defined ghost management of medical research and publishing:
On the Health Business Blog, this post by David Williams favorably reviews the just published book by Richard N. Fogoros, Fixing American Healthcare; Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare. Fogoros blogs on the Covert Rationing Blog.
A story from the Connecticut Business Journal suggests the extent that medical schools now seek money from for-profit health care corporations.
The Yale School of Medicine has mounted an aggressive fundraising campaign targeting drug makers, according to internal university documents recently reviewed by Business New Haven.The documents, part of a confidential briefing for School of Medicine Dean Robert Alpern, outline an effort to raise more than $40 million in philanthropic dollars through 2008 from pharmaceutical companies.