Myhealth - KiwiDoc

Been away a while

2008-04-12T17:02:00.002+12:00

Have been on an island off coast of NZ. The internet was a bit sluggish. Have satellite internet coming. Hope its fast enough. Have winter wood supply chopped up and ready. The work isn't too onerous. Plan organising my recent research and then see where that takes me. As I do this and if internet is adequate I shall be uploading heaps of good stuff.

see ya

Books to read

2008-04-12T16:50:00.010+12:00

Here's sample from Good Calories Bad Calories

And here a list of books to consider

If you get diabetes read this book Dr Bernstein Diabetes solution - he is a doctor with IDDM from his teens and is now in his 70s. Years ago he had complications of diabetes - most of these have gone. If I had diabetes I’d be seeing this guy.

If you worry abiut your weight read this one - Fat Politics J eric Oliver Phd . You folk with a BMI between 25 and 30 may live longer than those with BMI between 20 and 25.

If you want to know what is known and what is not known - from science point of view - about fat, diet, food etc read this - Good Calories bad calories Gary Taubes science journalist. It’s a bit detailed but this guy knows his stuff and most of what we, lay persons and doctors alike, think we know is BS.

If you have hypertension read the chapter on it in this book - Malignant Medical Myths Joel Kaufman Biochemist.

If you have been told you have prostate cancer read this one - Prostate cancer prevention and cure lee Nelson huntingdon press las vega isbn 0-929712-14-5. He’s a doc with tis disease. It’s a medical book and it is very detailed.

Any type of cancer - go to cancerdecisions. com. This is the website of ralph Moss. If I get cancer of any kind I will be buying one of his reports. About to have chemo or radiotherapy buy one of his books or less expensive reports.

If your doctor is raving on about cholesterol read this The Cholesterol Myth Uffe Ravnskov Medical doctor and this The cholesterol con by Malcolm Kendrick uk GP. Ask your doctor what absolute risk reduction is? Then ask what the NNT is ie number needed to treat. Then ask what the NNH is number needed to harm. Then ask what the mortality rate is for those who take the pills and those who don’t is. Is the absolute risk reduction about death or what?

If you are wondering about mammograms or PSA read these two - The last well person Nortin hadler professor medicine Should I be tested for cancer H Gilbert Welch professor medicine. Ask your doctor what the number needed to screen is to prevent one death.

If you are thinking about having an arthrocopy for OA of your knee or a back operation read the above book - The last well person.

If your surgeon wants to perform a coronary artery by pass on you read - The last well person. as well as Heart Frauds Charles T McGee Medical doctor

Overdosed America John Abrahamson. This guy is a or was a GP attached to harvard. He has a go at cholesterol, HRT, osteoporosis and a few other things - loved this book.

If you have familial hypercholesterolaemia read the above Cholesterol Con book.

Google Mary G. Enig, PhD to find out about fats.

That’s it for now folks.

Medical Myths

2007-11-09T10:57:00.000+13:00

Evidence-Based Medicine for Student Health Services
Robert J. Flaherty, MD
Swingle Student Health Service
Montana State University
Bozeman, MT 59717 Medical Myths
http://www.montana.edu/wwwebm/myths.htm

General	Hematology/Oncology	Pain Control
Allergy/Immunology	Obstetrics/Gynecology	Pulmonology
Cardiology	Ophthalmology	Radiology
Continuing Education	Orthopedics	Surgery
Endocrinology	Otolaryngology	Urology

Here is an example
. Myth: The United Kingdom Prospective Diabetes Study (UKPDS) of 5000+ patients followed over 20 years, showed:
a. Hyperglycemia in Type II diabetes is a continuous, modifiable risk factor for clinically important outcomes and that reduction in glucose is the key to improving outcomes
b. Tight blood glucose control is an important goal in Type II diabetes
c. Intensive treatment of Type II diabetes is beneficial

7. Reality: A closer and more objective look at the UKPDS data clearly shows:
a. The medications used (glibenclamide, chlorpropamide and/or insulin) to lower blood glucose concentrations produced no significant benefit on any single macrovascular end point for any group of patients
b. Metformin reduced progression of retinopathy and reduced the frequency of the aggregated diabetes-related endpoints, all cause mortality, and stroke compared with the sulphonylureas and insulin or diet alone
c. The benefit of metformin is not necessarily related to its hypoglycemic effect
d. Decreasing HgbA1c using medication did not improve any clinical endpoint

WHAT DO YOU MAKE OF THIS????

McCormack J, Greenhalgh T, Seeing what you want to see in randomised controlled trials: versions and perversions of UKPDS data, BMJ 2000 June 24, 320:1720-3. PMID: 10864554
Shaughnessy AF, Slawson DC. What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes. BMJ 2003 Aug 2; 327(7409): 266. PMID: 10864554

Mammography

2007-11-09T10:56:00.000+13:00

Bandolier on this subject

Breast screening again

2007-10-21T15:53:00.000+13:00

The Center for Medical Consumers takes the position that as long as one team of researchers found considerable harm and uncertain benefit, it remains unclear whether symptom-free women should continue having regular mammograms. Arguably, the analysis conducted by Gotzsche and Olsen is far more in-depth and more thoroughly peer-reviewed than other analyses of the same trials. Their critics have judged the increased- mastectomy finding to be obsolete because mastectomy is no longer the only treatment for breast cancer. But Dr. Gotzsche counters that in some countries, mammography-detected carcinoma in situ is currently treated with breast removal in about one-third of all cases (Letters to The Lancet, 2/1/02). This year alone, an estimated 54,000 U.S. women will be diagnosed with carcinoma in situ, according to the American Cancer Society. Most will be treated with six weeks of radiation therapy, and some will be treated with mastectomy.

Breast screening

2007-10-21T15:17:00.000+13:00

SCREENING FOR BREAST CANCER: WHAT TO DO WITH THE EVIDENCE

Harris, R., Am Fam Phys 75(11):1623, June 1, 2007

The author, from the University of North Carolina and a member of the U.S. Preventive Services Task Force, addresses the continuing controversy regarding breast cancer screening. He notes that screening is, on the whole, beneficial among women aged 50-69, leading to a modest reduction in breast cancer mortality (number- needed-to-screen [NNS] to prevent one death after 14-years, 838). The potential benefit is less in women aged 40-49 (NNS 1,792), while there is little evidence regarding women over the age of 70, who have been excluded from most studies. Screening over the course of ten years in any of these groups can be expected to produce at least one false-positive test in about 50% of women, prompting anxiety and further (needless, but potentially harmful) procedures. In light of this evidence, the author recommends that screening (every two years) be encouraged for women aged 50-70. For women aged 40-49, however, he recommends discussion of the possible harms and benefits, to allow them to make an informed decision. He similarly recommends shared decision making for women over the age of 70, while acknowledging the impossibility of providing them with any clear information about benefits and harms. He also notes that patients with a strong family history should be referred for genetic counseling. Finally, he cites good evidence that breast self-examination is not useful and should be discouraged, and notes that there is insufficient evidence regarding a possible role for screening MRI or other newer radiographic techniques. 12 references (afpserv@aafp.org)

The above abstract comes from here

Article below comes from here
The first stirrings began last December, after The Lancet carried an article by two Danish scientists questioning the value of breast screening. Peter Gotzsche and Ole Olsen caused an outcry two years ago by suggesting screening did not save lives, after reviewing the results of seven trials involving 450,000 women. In a follow-up article last October, they repeated their analysis and said they were now even more sure their earlier claims were correct. They concluded that the small difference in deaths was caused by the way the trials were designed, not by any effect of screening.

Harvard gazette

A New Study Provides Additional Reasons to Avoid High Doses of Statin Medications

2007-10-21T10:43:00.000+13:00

In articles posted at MedicationSense.com in recent months, I discussed the findings of two major studies of maximum-dose 80-mg Lipitor (atorvastatin). Despite the authors' claims that these studies proved the benefit of maximum-dose Lipitor for preventing heart attacks and strokes, the MedicationSense.com articles revealed that maximum-dose Lipitor caused far more liver injuries than placebo or low-dose Lipitor. Even worse, despite a reduction in heart attacks and a slight reduction in strokes, there was no improvement in overall mortality because more subjects on maximum-dose Lipitor died of other causes including cancer.

Should you take asprin to prevent heart attack

2007-10-18T22:54:00.000+13:00

Well should you
Thiw will downlaod a pdf file

Statins again.

2007-10-18T21:30:00.000+13:00

Talk given by Uffe Ravnskov in Sidney August 2006

Malcolm Kendrick. Short but interesting. WHO data

Aborigines have the highest rate of cardiovascular disease (CVD) - lowest cholesterol
Swiss have highest cholesterol and lowest CVD.

Evidence for Caution: Women and statin use A meticulous 36-pages report about the senseless and dangerous use of statins in women.

Are Statins Overused?, by Malcolm Kendrick

The above all come from here

Here is Ellison's E Book The hidden truth about cholesterol

According to Ellison, studies have consistently linked high cholesterol to lower mortality. For example:

Low cholesterol is associated with heart arrhythmia.

The European Heart Journal published a 3-year study of 11,500 patients finding those with low cholesterol to have a risk of all-cause death 2.27 times higher than those with high cholesterol.

The Journal of Cardiac Failure published an analysis of 1134 patients with heart disease and found low cholesterol to be associated with the worst outcomes in heart failure patients and impaired survival, while high cholesterol improved survival rates.

The American Geriatrics Society reported in 2003 that, in patients over the age of 65, even cholesterol levels up to 417 mg/dL were associated with lower mortality compared to levels under 189 mg/dL.

Flu vaccine

2007-10-18T16:42:00.001+13:00

The researchers found no evidence that the vaccine lowers therisk of admission to hospital in winter among elderly patientswith acute respiratory disease (Vaccine doi: 10.1016/j.vaccine.2007.09.005).

There are other papers that say just the opposite
Hows a poor statistical ignoramus t sort these things out.

Here one suggesting all we docs should take the needle

CONCLUSIONS: Programs to promote and facilitate influenza immunization for healthcare workers appear to reduce influenza-related morbidity and mortality in the elderly
Hayward, A.C., et al Br Med J 333:1241, December 16, 2006
RESULTS: Overall vaccination uptake rates, including full- and part-time staff, were 35% in intervention homes vs. 5% in control homes in 2003-2004, and 31% vs. 4% in 2004-2005. Vaccination rates among residents exceeded 70%. During 2003-2004, there was a statistical reduction in selected resident outcomes in intervention homes during the influenza season, including influenza- like illness (11% vs. 23%, NNT 4.5), hospital admission and GP consultations for influenza-like illness (0.3% vs. 2% [NNT 20.4] and 10% vs. 19% [NNT 5.8]), and all-cause mortality (11% vs. 15%, NNT 8.2). Similar trends were observed in 2004-2005, although overall influenza activity during that period was very low.

Should young people be given antidepressants?

2007-10-18T16:35:00.000+13:00

(1) Should young people be given antidepressants?
(Head to Head: Should young people be given antidepressants?)
Yes: http://www.bmj.com/cgi/content/full/335/7623/750
No: http://www.bmj.com/cgi/content/full/335/7623/751
Not sure whether this is free or not

serotonin syndrome

2007-10-16T16:45:00.000+13:00

The manifestations of the serotonin syndrome fall into three general areas:

Cognitive or behavioral changes such as confusion, agitation, lethargy, and coma.
A condition that is referred to as autonomic instability that includes elevated temperature, rapid heart rate, sweating, nausea, vomiting, diarrhea, and dilated pupils.
Neuromuscular changes that include spasm or twitching a muscle or group of muscles, exaggerated reflexes, and tremor.

Here's a list of drugs that have been associated with this according to article in bestpillsworstpills

cervical cancer vaccine

2007-10-16T16:28:00.000+13:00

Here is a question and answer format that seems straight down the middle.
It's 15 US a year to use this very worthwhile site.

Concerned re side effect

2007-10-16T16:15:00.000+13:00

It's only 15 US per annum.
The cut and paste below comes from here - it's free
Here is some more free stuff on drugs

Each year, in hospitals alone, there are 28,000 cases of life-threatening heart toxicity from adverse reactions to digoxin (DIGITEK, LANOXICAPS, LANOXIN), the most commonly used form of digitalis (drugs that regulate the speed and strength of heart beats) in older adults.
Each year 41,000 older adults are hospitalized — and 3,300 of these die from ulcers caused by NSAIDs (nonsteroidal anti-inflammatory drugs, usually for treatment of arthritis). Thousands of younger adults are hospitalized.
At least 16,000 injuries from auto crashes each year involving older drivers are attributable to the use of psychoactive drugs, specifically benzodiazepines and tricyclic antidepressants. Psychoactive drugs are those that affect the mind or behavior.
Each year 32,000 older adults suffer from hip fractures attributable to drug-induced falls, resulting in more than 1,500 deaths. In one study, the main categories of drugs responsible for the falls leading to hip fractures were sleeping pills and minor tranquilizers (30 percent), antipsychotic drugs (52 percent), and antidepressants (17 percent). All of these categories of drugs are often prescribed unnecessarily, especially in older adults.
Approximately 163,000 older Americans suffer from serious mental impairment (memory loss, dementia) either caused or worsened by drugs. In a study in the state of Washington, in 46 percent of the patients with drug-induced mental impairment, the problem was caused by minor tranquilizers or sleeping pills; in 14 percent, by high blood pressure drugs; and in 11 percent, by antipsychotic drugs.
Two million older Americans are addicted or at risk of addiction to minor tranquilizers or sleeping pills because they have used them daily for at least one year, even though there is no acceptable evidence that the tranquilizers are effective for more than four months, and the sleeping pills for more than 30 days.
Drug-induced tardive dyskinesia has developed in 73,000 older adults; this condition is the most serious and common adverse reaction to antipsychotic drugs, and it is often irreversible. Tardive dyskinesia is characterized by involuntary movements of the face, arms and legs. About 80 percent of older adults receiving antipsychotic drugs do not have schizophrenia or other conditions that justify the use of such powerful drugs, so many of these patients have serious side effects from drugs that were prescribed inappropriately.
Drug-induced parkinsonism has developed in 61,000 older adults also due to the use of antipsychotic drugs such as haloperidol (HALDOL), chlorpromazine (THORAZINE), trifluoperazine (STELAZINE), fluphenazine (PROLIXIN), and thioridazine (MELLARIL). There are other parkinsonism-inducing drugs as well, such as metoclopramide (REGLAN), prochlorperazine (COMPAZINE), and promethazine (PHENERGAN), prescribed for gastrointestinal problems.

Read this book - Overdosed America

2007-09-28T07:19:00.000+12:00

It's a very eloquent read re the depressing direction modern medicine is going in - it's written by an ex academic family doctor. In particular if you want a clear picture of the cholesterol saga, it's in this book.

Having fun - surely it must be good for you.

2007-09-14T01:41:00.000+12:00

Been on holiday - another month or two to go

2007-09-14T01:31:00.001+12:00

My brother and I with our Basque Berets - we reckon we look pretty good. Another month and I wil have to put my medical hat on - do some reading and catch up! Any ideas gratefully accepted.

Want to see my holiday snaps, NZ shots - help yourself here

When I get medical brain going again will start blogging here again.

Conversations with my brother re medicine and where its going are disturbing. Either I am becoming an old fuddy duddy or we are really heading down some dead end alleys - time will tell and I'd like to be live long enough to find out. Have fun - surely this is more important than living a few years longer.

xenical

2007-08-09T02:27:00.001+12:00

The Diet Drug Orlistat (XENICAL) and Gallstones
(June 2007)
Yet another problem has been detected with this diet drug whose approval we opposed and that we have been attempting to get banned. The FDA found 37 cases of gall stones in patients using orlistat. This, in addition to inhibiting the absorption of important vitamins such as A, D, E and K as well as evidence that the drug can cause pre-cancerous abnormalities in the colon of animals, further emphasizes why this barely effective drug should not be used, either in the prescription version called Xenical or the about-to-appear over-the-counter version, Alli.

Low-Dose Aspirin for Heart Protection: How Low Should a Safe Dose Be?

2007-08-09T02:22:00.000+12:00

Daily aspirin protects the heart, but the dose at which this can be safely accomplished has never been established. It has long been known that the risks of aspirin—gastrointestinal or brain hemorrhage—cannot be completely eliminated even at the lowest possible doses. An international team of researchers recently determined that daily doses of aspirin as low as 30 mg are adequate for achieving the anti-clotting goal; whereas doses higher than 75 to 81 mg merely increase the risk of adverse reactions without providing any additional advantage.

Screening for Stroke, Peripheral Artery Disease and Abdominal Aortic Aneurysm

2007-08-09T02:20:00.000+12:00

Mass screening for vascular disease is a relatively new idea. Before plunking down your money, the question to be answered is this: Have any studies proven that detecting and treating this symptomless problem will either prolong my life or improve its quality?

Avandia Debacle

2007-08-09T02:17:00.000+12:00

Scarcely two weeks after the Senate overwhelmingly passed legislation touted as a major fix of FDA’s failing effort to assure drug safety, The New England Journal of Medicine published an analysis linking the diabetes drug Avandia to a 40% increase in the risk of heart attack. This finding is especially troubling because people with diabetes are already at high risk of cardiovascular problems. A million diabetics are estimated to be current Avandia users in the U.S.

Se here for rest of article

BP oh dear

2007-08-09T00:07:00.000+12:00

Their findings were that 'Shockingly, we have found that the Framingham data in no way supported the current paradigm to which they gave birth. In fact, these data actaully statistically reject the linear model.'

Treating hypertension with guidelines in general practice

ARE ANTIDEPRESSANTS AS EFFECTIVE AS CLAIMED?

2007-08-09T00:04:00.000+12:00

NO, THEY ARE NOT EFFECTIVE AT ALL

Click here to hear the Reviewer's comments via MP3.

Moncrieff, J., et al, Can J Psych 52(2):96, February 2007

This British author challenges the tenet that antidepressant drugs specifically act on abnormal cerebral states to relieve depression. She points out that meta-analyses of the myriad of published randomized, controlled trials comparing antidepressants and placebo generally show only a small advantage of active treatment, further noting that trials with negative results are much less likely to be published. The author suggests that reported effects of antidepressant drugs might be due to nonspecific sedative effects of these agents on outcomes such as sleeping difficulties and anxiety rather than to a truly antidepressant effect. She cites the findings of naturalistic studies that have reported that patients treated with antidepressants do less well than those who are not so treated. The prevalence of depressive episodes, suicide and sickness absence due to depression has been progressively increasing in western countries, despite a profound increase in antidepressant prescribing, suggesting that the use of antidepressants has done little to reduce the consequences of depression. Addressing studies reporting relapse of depression after discontinuation of long-term antidepressant therapy, this author feels that this phenomenon does not necessarily provide evidence of the effectiveness of antidepressants but rather might reflect the occurrence of discontinuation symptoms that are mistakenly diagnosed as early signs of relapse. In support of this premise, she cites the findings of one meta-analysis of maintenance antidepressant studies reporting that relapses tended to cluster after withdrawal of treatment, with the risk declining thereafter. The author concludes that there is no reason to suppose that the diverse problems that are labeled as "depression" can be reversed by antidepressant drugs. 9 references (j.moncrieff@ucl.ac.uk)

Put this in your pipe and smoke it

2007-07-17T04:03:00.000+12:00

These trials, which had the lowest risk of erroneous results and a combined total of 180,938 participants, showed the following increases in mortality per antioxidant: 7% for beta carotene; 16% for vitamin A; and 4% for vitamin E ( the trials tested a wide range of doses; for example, Vitamin A doses ranged from 2,000 IU/day to 200,000 IU/day). The Cochrane reviewers concluded that ongoing trials looking at vitamin C and selenium should continue.

Menopause guidelines

2007-07-16T06:25:00.000+12:00

Here tis