Edmund’s Blog

Linda Lewis says that when she had back surgery two years ago, her surgeon didn’t do what was best for her health; he did was best for his bank account.
If Linda Lewis had known of her surgeon’s financial ties to a device maker, she’d have sought a second opinion.

If Linda Lewis had known of her surgeon’s financial ties to a device maker, she’d have sought a second opinion.

Lewis, a graduate student who lives in Sherman Oaks, California, says Dr. John Regan, a surgeon in Beverly Hills, put in an artificial disc to help relieve her lower back pain.

“He said my back would be better than ever,” said Lewis, 45. “I’m thinking, ‘Wow, disc replacement is the best thing since sliced bread.’ ”

But after the surgery, Lewis says, she ended up in debilitating pain, could walk only with the assistance of a walker and had to have a second procedure to correct the first one.

“I couldn’t take enough drugs for the pain,” she said. “Having that surgery was the worst decision of my life.”

Lewis said she was “livid” when she later found out that Regan had financial ties to the company that makes the disc, saying she believes that those ties prompted Regan to recommend the disc over other treatment options.

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One of the reasons people on low-carbohydrate diets may lose weight is that they reduce their intake of fructose, a type of sugar that can be made into body fat quickly, according to a researcher at UT Southwestern Medical Center.

Dr. Elizabeth Parks, associate professor of clinical nutrition and lead author of a study appearing in a current issue of the Journal of Nutrition, said her team’s findings suggest that the right type of carbohydrates a person eats may be just as important in weight control as the number of calories a person eats.

Current health guidelines suggest that limiting processed carbohydrates, many of which contain high-fructose corn syrup, may help prevent weight gain, and the new data on fructose clearly support this recommendation.

“Our study shows for the first time the surprising speed with which humans make body fat from fructose,” Dr. Parks said. Fructose, glucose and sucrose, which is a mixture of fructose and glucose, are all forms of sugar but are metabolized differently.

“All three can be made into triglycerides, a form of body fat; however, once you start the process of fat synthesis from fructose, it’s hard to slow it down,” she said.

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People have long prized silver as a precious metal. Now, silver-coated endotracheal tubes are giving critically ill patients another reason to value the lustrous metal. In a study published in the Aug. 20, 2008 issue of the Journal of the American Medical Association, researchers at Washington University School of Medicine in St. Louis and the NASCENT Investigation Group, report that the silver-coated tubes led to a 36 percent reduction of ventilator-associated pneumonia (VAP).

VAP can strike up to 15 percent of people who are intubated to aid breathing and can cause death in an estimated 20 percent to 40 percent of those stricken.

“VAP is a relatively common infection and increasingly one caused by antibiotic-resistant bacteria,” says the study’s lead author, Marin H. Kollef, M.D., a Washington University pulmonary specialist at Barnes-Jewish Hospital. “There have been many attempts to prevent VAP, most of which have revolved around modifying hospital practices. The silver-coated endotracheal tube has an advantage in that it doesn’t require any additional effort by nurses, therapists and doctors, who may already be over burdened.”

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In a landmark study, Medical College of Wisconsin researchers in Milwaukee report that drugs used to inhibit a specific fatty acid in rat brains with glioblastoma-like tumors not only reduced new blood vessel growth and tumor size dramatically, but also prolonged survival.

“These rat model tumors were developed from human glioblastoma tumor cells and closely mimic human tumors in growth patterns and response to therapy,” says lead researcher David Harder, Ph.D., Kohler Co. Professor in Cardiovascular Research. “The concept of targeting blood vessels that feed tumors as an approach to limit tumor growth is not a novel idea,” he says. “However, blocking the specific fatty acid described in this study is novel, and holds great promise for use in humans.”

Malignant gliomas are very aggressive tumors of the central nervous system, resistant to chemotherapy and radiation, and account for about half of the 350,000 brain tumors currently diagnosed in the U.S.

Dr. Harder is also professor of physiology, associate dean for research and director of the Medical College’s Cardiovascular Research Center. He believes that further studies, demonstrating that such drugs work in humans may reveal that higher concentrations or infusions over longer periods of time may be more effective than the results reported in this study.

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An epilepsy drug being tested for use in treating addiction can help obese rats shed weight, U.S. government researchers said on Wednesday.

Their findings point not only to an easy treatment for obesity, but show it is similar to drug addiction, they said.

Even rats bred to be obese lost up to 19 percent of their weight and normal rats lost 12 to 20 percent of their weight after 40 days of injections of the drug, called vigabatrin or GVG, the team at the U.S. Department of Energy’s Brookhaven National Laboratory found.

“When we gave GVG, they would steadily lose weight, and when we took them off GVG, they would steadily gain weight,” Amy DeMarco, who worked on the study, said in a telephone interview.

“It was like a roller coaster. It was also dose-dependent. Rats given higher doses would lose more weight.” She added that her team saw no side effects in the rats.

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The U.S. Food and Drug Administration today approved Nplate (romiplostim), the first product that directly stimulates the bone marrow to produce needed platelets in patients with a rare blood disorder that can lead to serious bleeding.

The condition, which usually develops in adults, is known as chronic immune thrombocytopenic purpura (ITP), a disease that results in a low number of platelets, the blood components that help with clotting. In patients with chronic ITP, the immune system is believed to destroy platelets and the patient’s bone marrow is often unable to compensate for this loss.

“This product is important in that it offers a new approach to the treatment of patients with an uncommon blood disorder who are often very ill,” said Janet Woodcock, M.D., director, Center for Drug Evaluation and Research, FDA.

The estimated 140,000 people with chronic ITP are prone to bruising and at risk for life-threatening bleeding. Current medical treatment includes corticosteroids and immunoglobulin. Surgery to remove the spleen, a procedure known as a splenectomy, may help some patients. Nplate is approved only for patients with chronic ITP who do not respond sufficiently to current treatments.

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FDA informed healthcare professionals that the Agency is investigating a report from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial of a possible association between the use of Vytorin and a potentially increased incidence of cancer. Vytorin is a combination product of simvastatin and ezetimibe used to decrease the production of cholesterol by the liver and inhibit the absorption of cholesterol in the intestine to reduce LDL-cholesterol levels and reduce the risk of cardiovascular events. Recently, FDA obtained preliminary results from the SEAS trial. The clinical trial tested whether lowering LDL-cholesterol with Vytorin would reduce the risk of cardiovascular events in individuals with aortic stenosis. A lower overall cardiovascular risk was not found with Vytorin. However, there was an additional observation that a larger percentage of subjects treated with Vytorin were diagnosed with and died from all types of cancer combined when compared to placebo during the 5-year study.

FDA anticipates receiving a final SEAS study report in about 3 months and the Agency’s review and evaluation of the clinical trial data and other relevant information should take approximately 6 months. FDA will communicate its conclusions and recommendations at that time. Healthcare professionals and caregivers should continue to monitor patients taking Vytorin and report side effects from the use of this drug to the Agency.

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Researchers at Johns Hopkins are reporting what is believed to be the most conclusive evidence to date that inadequate levels of vitamin D, obtained from milk, fortified cereals and exposure to sunlight, lead to substantially increased risk of death.

In a study set to appear in the Archives of Internal Medicine online Aug. 11, the Johns Hopkins team analyzed a diverse sample of 13,000 initially healthy men and women participating in an ongoing national health survey and compared the risk of death between those with the lowest blood levels of vitamin D to those with higher amounts. An unhealthy deficiency, experts say, is considered blood levels of 17.8 nanograms per milliliter or lower.

Of the 1,800 study participants known to have died by Dec. 31, 2000, nearly 700 died from some form of heart disease, with 400 of these being deficient in vitamin D. This translates overall to an estimated 26 percent increased risk of any death, though the number of deaths from heart disease alone was not large enough to meet scientific criteria to resolve that it was due to low vitamin D levels.

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Adverse events from antibiotics cause an estimated 142,000 emergency department visits per year in the United States, according to a study published in the September 15, 2008 issue of Clinical Infectious Diseases.

“This number is an important reminder for physicians and patients that antibiotics can have serious side effects and should only be taken when necessary,” said study author Daniel Budnitz, M.D., at the Centers for Disease Control and Prevention (CDC).

Prior to this study, detailed data on the scope and burden of antibiotic adverse events in the U.S. were not available. This investigation is the first to use timely, nationally representative surveillance data to estimate and compare the numbers and rates of adverse events from systemic antibiotics by class, drug, and event type.

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For patients with clogged heart arteries who take long-term, low-dose aspirin to prevent a cardiac event, adding a stomach acid-blocking drug to their daily routine has been shown to reduce their risk for upper gastrointestinal bleeding – an infrequent, but serious side-effect of regular aspirin use.

But do the benefits of these acid blockers – called proton pump inhibitors, or PPIs – outweigh their long-term costs?

In a new study, researchers at the University of Michigan Health System reveal that, from the perspective of a long-term payer, over-the-counter PPIs are worth the price for coronary heart disease patients taking low-dose aspirin as a preventative measure. At prescription costs, however, PPIs are cost-effective only for elderly patients and patients at high risk for upper GI bleeding.

“Our study was also able to demonstrate that, for patients at an average risk for GI bleeding, starting PPI cotherapy at a younger age was marginally cost-effective, while starting PPI cotherapy at an older age was highly cost effective,” says Sameer Dev Saini, M.D., M.S.,clinical lecturer in the Division of Gastroenterology at the U-M Medical School. ”Ultimately, physicians should discuss the gastrointestinal risks of low-dose aspirin with their patients and consider PPI cotherapy.”
Study results appear in the Aug. 11/25 issue of Archives of Internal Medicine.

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