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| Doctors, Economist Write Prescription For Protecting People From Themselves |
Policy makers, employers and others can use the science of behavioral economics to steer people toward wiser choices - and dramatically improve their health - without limiting their freedom to do as they please, according to an article published in the Nov. 28 issue of the Journal of the American Medical Association (JAMA). The paper was written by researchers at Carnegie Mellon University, the University of Pennsylvania, Aetna Inc. and the Philadelphia Veterans Affairs Medical Center.
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This approach can counter one of the underlying causes of major health problems in the United States and other developed nations - bad decision-making on the part of individuals. Tobacco use, obesity and alcohol abuse account for nearly one-third of all deaths in the United States. What's more, the full benefits of many medical advances - such as medication to control blood pressure, lower cholesterol and prevent strokes - go unrealized because people fail to adhere to their treatment. For example, the authors note that one year after suffering a heart attack about half of patients prescribed drugs to lower cholesterol have stopped taking them.
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So, why do people make choices they know are bad for them, or fail to do things, like take medication, which they know will be helpful? Unlike conventional economics, which assumes that when presented with adequate information people will make decisions that are in their own best interests, behavioral economics recognizes that individuals are prone to biases that impede their ability to make good choices. The authors advocate exploiting these decision-making biases to help people make better decisions - without taking away their freedom of choice - a strategy they label "asymmetric paternalism."
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| Drug Boosts Platelets in Hepatitis C Patients |
It's not a cure, but this may be some of the best news patients infected with the hepatitis C virus (HCV) have heard in a long time: A new drug, eltrombopag, appears to be effective in boosting low platelet counts, one of the major reasons why patients can't endure antiviral treatments.
Other drugs that can restore normal platelet functions are infusions or injections; eltrombopag is a pill taken just once a day.
Researchers at Duke University Medical Center and other centers world-wide studied eltrombopag (marketed as Promacta in the U.S. and Revolade in Europe by GlaxoSmithKline) in 74 patients with low platelet counts and cirrhosis of the liver due to HCV infection. They found that it boosted platelet counts in a majority of patients at each of three dosage levels, enabling most of them to continue or start conventional antiviral treatment.
The findings appear in the current issue of the New England Journal of Medicine.
"We feel this is an important development for many people infected with the hepatitis C virus world-wide," says Dr. John McHutchison, professor of medicine and associate director of the Duke Clinical Research Institute. "A significant number of patients with HCV infection will at some point develop platelet problems that will compromise their getting the best treatments we have. Anything we can do to prevent that from happening would improve their care."
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| Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature |
In the United States, selective serotonin reuptake inhibitor (SSRI) antidepressants are advertised directly to consumers. These highly successful direct-to-consumer advertising (DTCA) campaigns have largely revolved around the claim that SSRIs correct a chemical imbalance caused by a lack of serotonin (see For instance, sertraline (Zoloft) was the sixth best-selling medication in the US in 2004, with over $3 billion in sales likely due, at least in part, to the widely disseminated advertising campaign starring Zoloft's miserably depressed ovoid creature. Research has demonstrated that class-wide SSRI advertising has expanded the size of the antidepressant market, and SSRIs are now among the best-selling drugs in medical practice.
Given the multifactorial nature of depression and anxiety, and the ambiguities inherent in psychiatric diagnosis and treatment, some have questioned whether the mass provision of SSRIs is the result of an over-medicalized society. These sentiments were voiced by Lord Warner, United Kingdom Health Minister, at a recent hearing: " I have some concerns that sometimes we do, as a society, wish to put labels on things which are just part and parcel of the human condition". He went on to say, "Particularly in the area of depression we did ask the National Institute for Clinical Excellence [an independent health organisation that provides national guidance on treatment and prevention] to look into this particular area and their guideline on depression did advise non-pharmacological treatment for mild depression" [4]. Sentiments such as Lord Warner's, about over-medicalization, are exactly what some pharmaceutical companies have sought to overcome with their advertising campaigns. For example, Pfizer's television advertisement for the antidepressant sertraline (Zoloft) stated that depression is a serious medical condition that may be due to a chemical imbalance, and that "Zoloft works to correct this imbalance". Other SSRI advertising campaigns have also claimed that depression is linked with an imbalance of the neurotransmitter serotonin, and that SSRIs can correct this imbalance (see Table 2). The pertinent question is: are the claims made in SSRI advertising congruent with the scientific evidence?
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| Vitamin E Could Help 40% of Diabetics Ward Off Heart Attacks |
Vitamin E supplements can significantly reduce the risk of heart attacks and related deaths for diabetics who carry a particular version of a gene, according to researchers at the Technion-Israel Institute of Technology and the Clalit Health Services in Israel.
After 18 months of treatment, people with the haptoglobin (Hp) 2-2 gene who took 400 International Units (IU) of vitamin E daily had more than 50 percent fewer heart attacks, strokes, and related deaths than Hp 2-2 patients who took a placebo pill. 40% of individuals with diabetes carry the Hp 2-2 gene.
The researchers will present the results on November 5 at the American Heart Meetings in Orlando, Florida. The full study will appear in the November 21 online edition of the journal Arteriosclerosis, Thrombosis, and Vascular Biology.
Most of the difference came from the reduced number of heart attacks among those taking vitamin E. In the group of 1,434 Hp 2-2 individuals taking part in the study, seven people had a heart attack, compared to 17 who did not take the vitamin. Dr. Andrew Levy, of the Technion Faculty of Medicine, said there were no side effects observed in patients who took vitamin E.
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Energy Drinks May Pose Risks for People With High Blood Pressure, Heart Disease
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Downing an "energy drink" may boost blood pressure as well as energy, researchers said in a small study presented at the American Heart Association's Scientific Sessions 2007.
In the study, conducted by Wayne State University researchers, blood pressure and heart rate levels increased in healthy adults who drank two cans a day of a popular energy drink.
While the increases didn't reach dangerous levels in the healthy volunteers, the increases in blood pressure and heart rate could prove to be clinically significant in patients with heart disease or in those who consume energy drinks often, said James Kalus, Pharm.D., senior manager of Patient Care Services at Henry Ford Hospital in Detroit, Mich., and a former Wayne State researcher who led the study. "Individuals with high blood pressure and heart disease should be advised to avoid these drinks."
Most energy drinks contain high levels of caffeine and taurine, an amino acid also found in protein-containing foods such as meats and fish. Both have had effects on heart function and blood pressure in some studies. In contrast, "sports drinks" in general contain various mixtures of water, sugars and salts alone, without chemicals aimed at increasing "energy" or alertness.
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| Mayo Clinic Study Finds That After Heart Attack Most Patients Stop Taking Lifesaving Drugs |
Recovery from heart attacks is best served by continuing to take prescribed medications. Yet more than half of patients who have had a heart attack stop taking these lifesaving medications within three years, according to results from a Mayo Clinic study presented today at the American Heart Association's Scientific Sessions 2007 in Orlando, Fla.
The Mayo data also show that in the short term, smokers are more likely to discontinue taking all of their prescribed heart medications, whereas in the long term, data show that patients enrolled in cardiac rehabilitation programs tend to continue their medications at a higher rate than patients who do not enroll. The researchers suggest their data support a two-pronged strategy for improving the public's heart health: 1) target heart patients who smoke for education on complying with physicians' aftercare advice about continuing medications, and 2) encourage all heart patients to participate in a cardiac rehabilitation program, possibly increasing their likelihood of continuing prescribed treatments.
The study was designed to improve recovery and quality of life after heart attack by determining how well patients comply with physicians' recommendations. "It clearly documented that treatments exist that improve outcomes following heart attacks - but patients need to comply with the treatment regimens for the goal of improved patient health to be realized," says Nilay Shah, Ph.D., the study's lead researcher.
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| World's #1 Killer Set To Affect 500 Million People |
Elevated blood pressure levels are the leading cause of death across the world, causing more than 7 million deaths each year. According to a new research report from The George Institute for International Health, published in the journal Hypertension, blood pressure related diseases such as coronary heart disease and stroke are continuing to cause potentially preventable death and disability globally, with a particularly large burden in developing countries such as India and China.
Blood pressure related diseases are taking a massive social and economic toll on low income countries and crippling already fragile health systems. In 2005 the World Health Organisation recognised blood pressure-related diseases as a major cause of premature death and disability and a serious threat to social and economic development. With massive populations and limited resources, developing countries are struggling to manage the rise in affected patients.
Many lower income countries lack the infrastructure to identify those at risk of blood pressure related diseases. According to author Dr Vlado Perkovic at The George Institute, "Scores of people in these regions are unaware that they have high blood pressure. What's needed are new approaches to the identification and treatment of individuals at high risk of blood pressure related diseases, utilising low cost but highly effective therapies that are already widely available. Health care providers must be trained and encouraged to provide screening, risk assessment and monitoring. The emphasis then moves to prevention rather than treatment, which is much more cost-effective for most nations."
By 2025, more than 1.5 billion adults across the world are expected to be affected by elevated blood pressure. In high-income regions, the numbers of hypertensive individuals are predicted to grow by 70 million, compared to a rise of 500 million in developing countries. Fortunately, blood pressure lowering drugs have played an important role in reducing the prevalence of blood pressure related diseases in most developed countries. However, this has not been the case in low income countries, and as the prevalence of elevated blood pressure continues to rise, these countries face a huge looming burden of disease.
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Believe it or not
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Viagra pumps up Thai political race
Vote-buying is an old practice in Thai politics, but one candidate for December's Thai election has reportedly come up with a new tactic - handing out Viagra instead of cash.
The allegation, made Thursday by a campaign worker against a rival party, comes as rules about handing out favors to voters have become stricter than ever, barring even the distribution of free T-shirts and soft drinks.
Sayan Nopcha, a campaigner for the People's Power Party in Pathum Thai province just north of Bangkok, said the drug used to treat sexual dysfunction in men was being distributed to elderly male voters at social functions.
Viagra is supposed to be used only on a doctor's advice, but is generally available over the counter in Thailand.
"The politician is giving out Viagra to gain popularity and votes," said Sayan, a local government official whose older brother is the PPP candidate. "I think this is a very bad way of vote-buying."
He would not identify the candidate who allegedly handed out the pills.
Under a tough new law, both the supplier and recipient of vote-buying can face criminal charges. Candidates can be disqualified and their party disbanded, as was the case with the old law, while voters who accept money or gifts can now face from one to 10 years in prison.
More than 4,200 candidates from 41 parties are competing for 480 seats in the lower house of parliament in the Dec. 23 polls - the first to be held after a bloodless military coup ousted elected Prime Minister Thaksin Shinawatra in September last year.
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