February 27, 2008

Big Pharma Lives to Cheat Again

Two stories in the news this week reflect increased scrutiny of Big Pharma malfeasance coupled with evidence that this scrutiny isn't going to change anything soon.

1. After many months of running the ad campaign where Robert "I am not a licensed doctor, but I play one on Television" Jarvik promoted Lipitor, Pfizer announced it was ending the campaign.

Pfizer to End Lipitor Campaign by Jarvik (NY Times)

This might look like a triumph for those who pointed out that "Dr. " Jarvik was never licensed to practice medicine, that he didn't actually invent the artificial heart, and that the footage of a man looking exactly like him indulging in energetic rowing was actually shot using a body double, since Jarvik doesn't row.

But it isn't that significant because this ad campaign has been running for so many months already that it was due to be replaced. Pfizer is hard at work on yet another campaign whose message is that the you shouldn't use a cheap generic statin. If you do, Pfizer's profits will tumble.

This deceptive ad campaign was very suited for Lipitor. This is, after all, the most misrepresented drug in history. Research studies have shown that statins do not prevent heart attacks in anyone except males under 56 years old who have already had heart attacks.

Statins do cause significant cognitive symptoms--including what can be permanent memory loss. They can compromise your liver. They can even weaken your heart muscle. But such is the power of the saturation advertising pursued by Pfizer and other statin manufacturers that few doctors are informed about the actual data supporting the claims that statins prevent heart attack.

2. Our second story is about the second most oversold family of drugs, SSRI antidepressants. Scientists invoked the Freedom of Information Act to get access to the many studies submitted to the FDA as part of the drug approval process for a long list SSRI antidepressants. In many cases, the publication of these studies had been suppressed by the drug manufacturers. In others they had been published with critical information left out so that misleading conclusions could be drawn.

The latter is a common practice. If, say, a placebo cures 30% of those who take it and the drug under study cures 30% of those who take it--which shows it is no more effective than a sugar pill--a misleading way of publishing the study would be to leave out any mention of placebo and headline the study, "New Drug cures 30% of those who take it." This, it turns out is exactly the way that the SSRI manufacturers spun a bunch of studies.

The meta-analysis of this suppressed and misrepresented data showed conclusively that SSRI antidepressants don't work any better than sugar pills except in the case of people with severe depression where they are only slightly more effective. Severe depression is the kind of depression that renders a person completely unable to function. Untreated people who have it end up institutionalized. It is not the mild depression that characterizes 98% of those prescribed Prozac, Zoloft, Paxil, etc.

You can read the published research paper about the actual effectiveness of SSRIs here in the metastudy published in Public Library of Science (PLoS) Medicine :
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

You would think this would have been front page news, given how these drugs have been prescribed to over 40 million people. But since drug company advertising heavily funds most media outlets in the U.S. the story went almost unreported. Fortunately, the British press which is not allowed to advertise drugs picked it up and that brought it to my attention.

What many people don't know about depression is this: studies conducted decades ago found that if you give psychotherapy to a group of people with mild depression one third will get better. But if you give no treatment at all to another group of people with mild depression one third will also get better. So with that in mind, you can reinterpret the way that drug companies promote these drugs with statistics showing, you guessed it, that one third of those given the drugs get better.

Unfortunately, getting better using an SSRI also means getting fatter, increasing your insulin resistance, decreasing your sexual function, and developing a dependency on the drug that will cause you to suffer serious neurological symptoms if you try to stop taking it.

And as I reported a few blog postings ago, taking an SSRI also seems to remodel the neuron distribution in your hippocampus, an effect whose long-term impact is unknown but should be troubling. Changes to the hippocampus as we age cause dementia.

What is even more troubling is that it took more than 20 years for the suppressed studies to see the light of day. This is long enough for many of the drugs involved in those studies to go off patent, after earning billions for the companies that suppressed the evidence that they were selling expensive, addictive placebos that have frightening side effects and most definitely increase insulin resistance.

If you care about your health, demand that your elected representatives change the laws that allow drug companies to sell their drugs to the public via television advertising. These ads are alway full of misrepresentations, but the drug companies know that by the time they get nailed for them, the ad will have already been seen hundreds of times by hundreds of millions of medically naive consumers.

And if you care about health, you should also demand that your elected representatives demand that the FDA make public all studies submitted as part of the drug approval process. Before the drug is approved.

Our ability to trust the safety of FDA-approved medications is lower now than it has been at any time since the FDA was first chartered to protect the public from drugs that were maiming and killing people. If the system isn't cleaned up, it is only a matter of time until we have a drug-induced disaster that will make the effects Thalidomide look trivial.

For that matter, we may already have had it. It may just take another decade for people to realize it.

February 24, 2008

How ADVANCE differs from ACCORD

As you all know by now, information about two major studies hit the press in the past few weeks. One, ACCORD, appeared to find that lowering the average A1c of a group of participants to 6.4% slightly increased the cardiovascular death rate.

The other study which lasted longer and enrolled twice as many people found that lowering the average A1c of study subjects to 6.4% resulted in no additional deaths.

There's been a lot of speculation about why these two studies came up with different results.

I did a bit of hunting to see if I could find out more about the details of these studies, and the little I have been able to find points to some important differences.

1. DIET. Contrary to speculation participants both studies were eating high carbohydrate diets. In ACCORD this was explicit. Nutritionists were assigned to hound study subjects on a regular schedule to eat a high carbohydrate/low fat diet.

In ADVANCE there was no formal dietary intervention. However, since the study was begun in 1999 at a time when it was a strongly held medical belief that low carb diets were dangerous for people with diabetes and since the study was conducted in countries where government-provided health care insisted patients follow a high carb/low fat diet, it is likely that participants in that study were eating a high carb diet, too.

2. BLOOD SUGAR DRUGS. According to the NIH patients in ACCORD were given "metformin; thiazolidinediones, or TZD's (rosiglitazone, pioglitazone); injectable insulins; sulfonylureas (gliclazide, glimepiride, glipizide, glyburide); and acarbose and exenatide."

Patients in ADVANCE were given only Gliclazide, (Diamicron), a sulfonylurea drug. Since it is dangerous to take this drug without a high carb diet, due to its ability to provoke serious hypos, this is more evidence that the diets in both studies were high carb/low fat.

But the fact that Avandia and Actos were not used in ADVANCE is suggestive.


Patients in ACCORD were given a wider selection of blood pressure drugs as the ACCORD design promoted using every possible drug available. I cannot find the explicit list of drugs, but given the design of the study, I would suspect it included ACE inhibitors, diuretics, and beta blockers.

Patients in ADVANCE took only a perindopril-indapamide combination. The first is an ACE inhibitor, the second a diuretic.


Patients in ACCORD were put on high doses of statins. Then a fibrate was added to this.

Patients in ADVANCE were NOT given any cholesterol treatment as part of the study.


The ACCORD study violated all the principles of good science because it introduced far too many independent variables. ADVANCE limited the variables under study making it much easier to interpret their effect.

The subjects in ACCORD were taking Avandia, Actos, and Byetta all of which are new. We now know that Avandia increases heart attack. We also know that Actos and Avandia both cause heart failure in people who didn't have it before starting the drug. Byetta is new enough that we don't know what it's impact on the heart is, long term.

If ACCORD did use beta blockers, that may be a factor in the increased deaths too. While these drugs on their own can prevent heart attack, reading their Prescribing Information makes it clear that they can also trigger heart attack in some situations. Also, they can be toxic to people whose livers aren't working properly. Avandia, Actos and statins can all affect liver function. When all these drugs are taken together, it is possible that small changes in liver function might have had an impact on the effects of beta blockers. (Or, for that matter, any other drug being taken.)

Finally it is possible that the use of STATINS and fibrates to pursue aggressive cholesterol control in the ACCORD trial is at fault. Or that these drugs work synergistically with some of the blood sugar drugs to cause problems.

The Vytorin study found slightly more growth of plaque in the arteries of people pursuing more aggressive cholesterol control.

But the study design of ACCORD is so sloppy, it is not likely we will ever know exactly what the problem with its protocol was.

For details on the study protocols visit:

ACCORD: NIH: ACCORD Questions & Answers

ADVANCE Study Rationale and Design of ADVANCE

February 19, 2008

Where's Our Apology?

Among the bigger news stories last week was the report about how Australian PM Kevin Rudd delivered a major apology to the Aborigine people for past governments' policy of taking their children away from them.

This got me imagining a scenario where Dr. John Buse, President of the American Diabetes Association, would step up to the podium and tell a roomful of reporters that he was there to apologize on the behalf of the ADA for condemning three generations of people with diabetes to lives filed with unnecessary complications and early deaths because of the ADA's aggressive advocacy of the high carbohydrate/low fat diet which makes it impossible for most people with diabetes to control their blood sugars.

In my fantasy, Dr. Buse would announce from now on the ADA would refuse to take money from companies whose primary products are high carbohydrate foods. He would add that the ADA was going to dedicate a large part of the millions of dollars contributed by friends and relatives of people with diabetes to the task of teaching doctors that cutting out the carbohydrates is a more powerful tool for lowering blood sugar than any drug on the market. He'd conclude by announcing that he was appointing Gary Taubes to head a new Expert Panel whose job would be to rewrite the ADA's position papers on diet and medication and that Dr. Richard K. Bernstein would be heading up a panel to rewrite the ADA's recommended blood sugar targets.

Ah, well. I'm not holding my breath. But today's news did carry an encouraging tidbit. As of October, Medicare has announced that it will no longer pay to treat a list of medical conditions caused by the negligence of hospitals and doctors!

Medicare Won't Pay Hospitals for Errors--AP

I have always wondered why doctors could get away with charging customers to fix conditions that resulted from their own incompetence. None of the rest of us can. Now it looks like Medicare may be able to change this. Not only will Medicare not pay for treating hospital-borne infections, sponges left in bodies, inappropriately used catheters, etc. but the hospitals and doctors will be forbidden from passing on the costs of treating these problems to patients. Private insurers are already following suit, and doctors may finally start washing their hands and counting the sponges as if people's lives depended on it--which they do. The report in my local paper explained that it wasn't until hospital administrators learned that these errors would cost them money that they got serious about eliminating them. Before Medicare announced this policy, the hospitals were earning an extra $100,000 per patient for each medical mistake.

On reading this, it struck me that it may, after all, be the bean counters who save us from bad medical treatment. Will it be Medicare that prohibits hospitals from putting people with diabetes on the high carbohydrate diets that make it impossible to control their blood sugar, now that there is evidence hospitalized patients recover more quickly and with fewer complications when their blood sugar is kept in the true normal range?

Right now doctors have no incentive to get their patients' blood sugars down. They earn money only when the patient comes into the office with a problem. Hospitals don't see people with diabetes until they have that heart attack, need dialysis, or have that amputation, all of which earn them good money, too.

So its up to the bean counters--the people who know what it costs to fund all that bad medical advice--to save us. And who knows, perhaps someday we people with diabetes will get our apology AND the kind of hospital and medical treatment that would help rather than hinder our search for health.

February 13, 2008

What Does That Pharmaceutical Drug Actually Do? This Question Never Answered Before Drug Approval!

Though there were a lot of interesting stories in the news this week, the most interesting one seems to have been published without anyone in the media noticing it.

As reported in The Journal of Neuroscience,scientists seem to have finally discovered how Prozac really works.

For years the drug companies have been explaining that Prozac and other SSRI antidepressants work by raising serotonin levels in the brain, though this hypothesis was never well-supported by research, even though it was used very heavily in the marketing of these drugs.

Now, decades after this drug was prescribed to millions of people, researchers have learned that what Prozac really does is to stimulate the growth of new neurons in the hippocampus, the portion of the brain that, among other things, regulates how new information is stored in the brain and which, when it is damaged, produces dementia.

In some elegantly constructed rodent experiments the researchers showed that Prozac lessened the anxiety of mice given the drugs when compared to that of controls, and that it did so after the same time delay that humans experience before they respond to an SSRI drug.

Sure enough, when they looked at the brains of the mice who displayed the dramatic change in behavior, they saw that the change correlated with the growth of new neurons in their hippocampi.

Then the scientists irradiated the mouse brains in a way that prevented the growth of new neurons after taking the drug. Though their serotonin levels increased, these mice remained anxious, and on autopsy it was seen that indeed they hadn't grown those new neurons. Unless those new neurons grew in the hippocampus, the mice stayed "depressed".

What should make anyone not taking a drug that has modified how they store new information feel a lot of anxiety is the realization that it has taken almost 30 years after Prozac was approved by the FDA for anyone to investigate what it is really doing to the brain in a way that gives a valid answer. And what is even more worrisome is that the answer is one that should make any reasonable person ask, "Does anyone here have any clue what happens longterm when you continually stimulate the growth of new neurons in the part of the brain most closely associated with dementia?"

This brings home to me just how dangerous it is to take a drug year in and year out whose mechanism is not understood.

The general public has a touching but completely misguided trust that the drug approval process ensures their safety when they take a new drug. But what most people don't understand is that all the drug approval process ensures is that the new drug has some effect--however small--compared with a placebo and that it doesn't cause major organ failure or fast growing cancers during the period of up to two years that the typical drug approval trial lasts.

There's no requirement that the long term effects of the drug be monitored in any meaningful way. And there is certainly no requirement that research be done to illuminate exactly what the drug is doing to the body.

That is why it took about 12 years after the release of Avandia and Actos for scientists to get around to noticing that these drugs actually work by turning the stem cells that should turn into bone cells into baby fat cells instead, which over the long term causes serious ostoporosis leading to fractures.

This failure to investigate how drugs really work is why only now, decades after statins became the most heavily promoted drugs in history, evidence is accumulating that whatever impact these drugs have on heart disease--which turns out to be not much except in men under 56 with previous heart attacks--they appear work NOT by lowering LDL cholesterol, but by fighting inflammation.

This should make all of us think twice before taking any new drug, no matter how effective it is at doing what it is being sold (and tested) to do.

Before you add a new drug to your daily regimen, remind yourself that the explanation of how the drug achieves its effect printed in the drug's official Prescribing Information is probably nothing more than a guess. It might be decades until the actual effect that a powerful new drug has on the many interrelated systems of your body comes to light.

Scientists still don't fully understand how Metformin works, and it has been around for decades. What they are learning about the impact of TZD drugs, Avandia and Actos, on bone growth should make any thinking person give them a wide berth. The effect of inhibiting DPP-4, as Januvia and Galvus do, on anything but blood sugar levels has yet to be explored, though it is clear the enzyme in question is used all over the body, especially in the immune system. Even the long term impact of using insulin analogs which contain chains of amino acids that differ subtly from those of the insulin our body produces is a complete mystery.

As a scientist quoted in the article about the effect of Prozac on the brain says, "We still don't know, of all the effects Prozac has on young neurons, which ones are important." Another adds, "We need these leads to understand the cellular and circuit changes that occur with chronic drug administration to learn what the entire system is doing,"

Yes. We do. As we need to learn more about what every drug that millions of people are taking every day, year in and year out is doing.

Though you might want to take a drug that decreases your anxiety before you read the studies that answer those questions. . . .

February 12, 2008

Diabetes Does Not Preclude a Long Life

Today's news contained a report about a study of centenarians which came up with the cheering news that neither diabetes or obesity prevents people from living to be 100.

Here's the original AP News Release:

Reaching 100 Is Easier Than Suspected

What fascinated me was the way that newspapers headlined this story. In keeping with the media's unending need to demonize diabetes and obesity, this same story ran with headlines like these:

Men Who Maintain Healthy Habits Lead Much Longer Lives

Key to longer life may lie in keeping fit from the age of 70, says study

In fact, the studies cited did not say that. The researchers admitted that genes appear to account for 25% of the likelihood of longterm survival. Many centenarians come from long-lived families. And the data about the relationship of risk factors and aging applies only to men. Women are much more likely to live to be old no matter what their health issues might be.

But here's where the reporting of this story gets interesting. Most of the news reports based on the AP story left out a graph the AP had prepared to accompany the article, though the graph did appear in my wonderful small town daily paper, The Greenfield Recorder.

These other media reports merely noted that men without any of these risk factors--which was translated into "men with a healthy lifestyle" had a 54% chance of living to be 90 and those with all the risk factors--translated into "an unhealthy lifestyle" had a 4% chance of living that long. These reports left out the information about the extent to which each factor decreased the risk of a 70 year old man's living to be 90.

Here's the chart:

What it appears to show is that:
  • Being sedentary decreases 70 year old men's chances of living to 90 by 10%.
  • Being obese decreases 70 year old men's chances of living to 90 by 10%
  • Diabetes (which probably means an A1c > 7%) decreased 70 year old men's chances of living to 90 by 4%.
  • Smoking decreases a 70 year old men's chances of living to 90 by 3%

A combination of factors appears to have a stronger impact on survival than the factors on their own.

Why is this good news? Because you can eliminate high blood pressure and high blood sugar by lowering your carbohydrate intake significantly, and, if that doesn't get the job done, by adding one or two carefully chosen drugs.

You can deal with the problem of being sedentary by taking a 30 minute walk every day. There's a lot of research that seems to find that this is all you need to do to make a difference in your health. Heroic exercise, such as lifting heavy weights and running, is, in fact, more likely to cause the kinds of joint and tendon injuries that will render you sedentary as you get older than is walking.

You can stop smoking.

That leaves one last factor that is harder to deal with especially as you get older, which is obesity. Since several studies based on NIH NHANES data have made it clear that losing weight for any reason after age 70--including dieting--appears to increase your chances of dying, I'm not certain that it is a good idea to diet aggressively at that age.

But even so if you are male and you address the other factors, you've improved your chances of living another 20 years from 4% to 44% which is not all that much worse than those lucky people--most of whom have the good genes which kept them from obese--who have that 54% chance of long term survival.

The one thing missing in these statistics is data about how many of these men survived in the kind of shape you'd want to survive in. A different NIH-funded study published this past October found that fully 34.4% of people who 90 or over had dementia and one in 7 over the age of 70.

One in Seven Americans Age 71 and Older Has Some Type of Dementia, NIH-Funded Study Estimates

Living a decade or two with dementia can be a fate worse than death, and the more healthy you are otherwise, the more likely that is to happen. Furthermore, many otherwise healthy people in their 90s are deaf or have lost their vision thanks to age-related macular deterioration.

And of course, there's one last problem with living to be very old that seems to be the hardest to deal with for the people I've seen live through their 90s: their friends are not as lucky and die. Living on when your closest friends and relatives--including children--are all gone can be difficult.

Personally, I think the focus should not be on long life as much as on quality life. I don't want to live into my 90s if it means being deaf, blind or demented, nor would I want to outlive all the people I love, particularly my kids.

But if you have been burdened by the belief that a diagnosis of diabetes means you are going to die much younger than normal, these statistics should cheer you up.

I recently got an email from someone complaining about her 80 year old father's refusal to do anything about his diabetes. I also have gotten mail about 90 year olds who insist on eating too much carbohydrate. I find these reports extremely comforting. You better believe that if I make it to 80 I'm going to eat whatever I please.

No one in my family who has made it through their 90s has done it in any kind of shape I'd like to be in, so a nice swift heart attack at 89 seems to me to be a lot better option than a painful cancer--especially since chemotherapy in people in their 80s almost always leads to dementia--or a series of strokes.

Everyone dies of something, and a massive heart attack is probably the most merciful of all the alternatives. And after I've done what I can do to improve my chances, I'm not going to obsess about long life. Instead, I'm going to make sure that I spend the days allotted to me in such a way that when it is time to go I'm ready, having done what I came here to do, seen what I came here to see, and loved who I came here to love.

February 8, 2008

Blame that Plastic Baby Bottle

I have long contended that it is impossible for toddlers to develop Type 2 diabetes through overeating and lack of exercise. It takes more than a decade for adults to develop diabetes due to obesity. And quite a few studies have shown that toddlers with normal metabolisms regulate their food intake with surprising precision and will not become overweight even if given unrestricted access to food.

So it comes as a welcome bit of news that a recent study has found that Bisphenol A is leaching out of plastic baby bottles at an alarming rate, especially when these bottles are warmed. Here, at last, we find a very likely contributor to the epidemic of childhood obesity and Type 2 diabetes: Bisphenol A is a chemical known to disrupt endocrine function which has been tied to the development of diabetes and obesity in lab animals.

You can read the actual study by downloading the PDF you'll find linked on this page from the Center for Health, Environment & Justice:

Baby's Toxic Bottle

To quote the web page just cited, "BPA, a synthetic sex hormone that mimics estrogen, is used to make hard polycarbonate plastic. Ninety-five percent of all baby bottles on the market are made with bisphenol A. The results of the U.S. study show that, when new bottles are heated, those manufactured by Avent, Evenflo, Dr. Brown’s and Disney/First Years leached between 4.7 – 8.3 parts per billion of bisphenol A. Recent research on animals shows that bisphenol A can be harmful by disrupting development at doses below these levels."

The only scientists who question the harm done by this plastic that is used throughout our food supply are those on the payroll of the plastics industry.

While the presence of Bisphenol A in babies' and toddlers' blood streams may explain the early onset of the kinds of obesity that are not normally seen in children who have normal metabolisms, the exposure to this chemical and many other plastics suspected of disturbing endocrine functions doesn't end with the end of bottle feeding. Sippy cups are plastic. Water bottles are plastic. Ketchup and salad dressing bottles are plastic. Dishware and unbreakable glasses are plastic. Microwave trays are plastic. Your organic vegetables from the so-called "health food" store sit on plastic trays wrapped in plastic. It goes on and on.

Another related recent story found dangerous levels of phthalates in the bloodstream--another organic chemical which damages the body. Who knows what other plastics are leaching into us and what they are doing?

Plastics, you must remember, are made out of organic molecules and organic molecules have this way of fitting into the receptors in our bodies designed for something else and disturbing their function.

So yes, people may be obese because they overeat--but they may be overeating because vital receptors have been clogged by these organic compounds that are similar enough to substances like estrogen and other hormones to fit into receptors meant for them. The presence of these foreign organic molecules we call "plastic" are very likely to be disrupting the complex systems that regulate appetite, weight, and blood sugar metabolism.

The energy spent blaming victims of this unfolding disaster for their obesity and diabetes has taken attention away from the questions that should have been asked--like why are children too young to be able to eat themselves into any metabolic disease suffering the kinds of metabolic disruption we only see in animals with abnormal genes or those who have been intentionally poisoned in the lab?

We're getting some answers now, but it may be years until action is taken. Meanwhile our entire population has bodies laced with these chemicals, which may have become permanent parts of them. And while we are waiting for more evidence, you can count on industry representatives to continue to claim that their products are harmless, just like the cigarette industry did--very successfully--for a full 30 years after scientists linked cigarette smoking to a wide variety of cancers.

It will take a long time to get answers to the question of how much damage these plastics that infuse our environment have caused. Most medical research is funded by drug companies for whom the obesity and diabetes epidemics represent a golden opportunity to make money from each and every victim. A person with diabetes will have to take three or four expensive pills every day for the rest of their lives. Curing the diabetes epidemic would send their stock prices tumbling.

Other sources of funding have dried up, most notably government research dollars. Bush & Co. have done all they can to gut the government organizations like the EPA whose mandate use to be to protect the public. The EPA now spends its limited budget campaigning against laws that would limit pollution. So there is little money available to scientists who want to research questions like what the true impact is of these toxic plastics that are circulating in our blood streams. And for every dollar academic scientists scare up to look at these questions, ten are spent by the chemical industry to obscure the issue.

Don't let yourself be fooled! Demand that your elected representatives increase public funding for science that protects the public. And in this upcoming election, be sure that whatever your party affiliation you elect representatives whose records show that they respect science and that their support for "life" doesn't end the day a baby is born.

February 6, 2008

My Take on ACCORD

I've heard from quite a few people today asking me what I think of the news that the ACCORD study seems to have found a connection between lowering the A1c below 7% and having cardiac patients die more frequently.

Deaths Partially Halt Diabetes Study

I'd like to see a more detailed report on the actual findings than what is currently appearing in the press,There is very little information here about what were the actual protocols used in this study. Follow up releases include claims supplied by the maker of Avandia that the study did not connect the excess deaths with the use of Avandia or "any drug."

But the little I could find about how this study was designed suggests that it may be impossible to tease out what really caused the excess deaths, because the study participants were given not only a wide variety of blood sugar lowering drugs, but also an aggressive blood pressure lowering drug regimen, and they were put on the aggressive combination of fibrates with statins to lower their LDL.

Here's the NIH description of the study:NIH Study Will Test Best Ways to Lower Risk of Heart Disease and Stroke in Adults with Type 2 Diabetes.

Clearly the participants in this study were ALL taking a large number drugs which were interacting like crazy with each other in a large number of possible combinations, any one of which might be causing the excess deaths.

For example, we recently learned that lowering LDL by combining a statin with another LDL lowering agent may thicken plaque, as that is what happened when Zetia was added to a statin. We also know that for people with compromised liver function the Beta Blockers used to lower blood sugar can actually be toxic (that information is in the prescribing information) and that both statins and TZDs can each affect liver function. What happens to the liver when both kinds of drugs are prescribed at once along with fibrates may never have been studied before.

The glaring omission in this study is this: There was no control group which lowered their A1c without the use of drugs. All the participants were taking drugs, lots of them. So we have no true way of knowing if it was the lowered blood sugar or the drugs causing the excess mortality. This really is a shame as many of you reading this are people diagnosed with diabetes who have lowered your blood sugars below 7% using carb restriction and exercise alone. So there is no reason that such a control group could not have been included.

But this study only involved people taking drugs, so we can be pretty sure that the people with lower blood sugars in this study took MORE drugs than those with higher blood sugars and that it is likely that it is some effect of the interactions of these drugs to blame if, as is claimed in the GlaxoSmithKline press release the data could not point to a clear connection between ONE drug and the excess deaths.

If we ever get access to more data I'll be sure to let you know what it tells us. We all have learned by now that what the headlines tell us a study shows is often NOT what the study actually shows, and that will probably be the case here.

My own experience after almost ten years of keeping my A1c in the 5% range is that despite doctors spending an unholy amount of their time and my money trying to prove that I must have heart disease since I have diabetes and eat a low carb/high fat diet, I've come up clean on the scans, treadmill tests, monitoring, and everything else they could throw at me.

February 5, 2008

Inconsiderate Thin People Cost Society a Bundle

After being deluged for years by media health pundits claiming that the costs of treating fat people are draining society dry it came as a refreshing surprise to read that when scientists actually did a study to determine the exact costs of all that obesity, they learned that it is not the obese costing society the most money. It turns out it's those damn thin people racking up the big bills.

Here's the story: Fat People Cheaper to Treat, Study Says

Here's the most interesting paragraph from the news report about the Dutch study that examined health histories of 1,000 people:

"Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.

"The cost of care for obese people was $371,000, and for smokers, about $326,000."

An American researcher unconnected with this study commented that the previous claims that the obese were going to bankrupt society were based on "guesswork, political agendas, and changing science."

Clearly, it's time to stop bashing the obese and to start demanding that those selfish thin people do something to shorten their lives so we don't end up paying almost $100,000 extra per person to support them in those old age homes where they live out the slow deterioration made possible by their inconsiderate pursuit of fitness.

It's also worth noting that this study also found that while the obese had more diabetes, the thin had more strokes. Given a choice, I'd take diabetes over stroke any day. You can do something about diabetes. Stroke pretty much makes you its victim.

But joking aside, what this study really points out is how often the statements we read in the press about health issues are nothing more than guesses deriving from prejudices and reinforced by repetition, rather than information derived from well-constructed studies.

In another, related example, in March of 2004, Dr. Julie Gerberding, the head of the CDC, made the statement to the press that obesity caused 400,000 deaths a year. This was trumpeted throughout the media. But a study published by her own organization, the CDC, on April 20, 2005 in The Journal of the American Medical Association made it very clear that she'd pulled this impressive figure out of her imagination. The CDC research study published in JAMA found that the number of deaths attributable to obesity was actually 25,814. Not 400,000.

Did this second, research-supported, number get bruited around the media? No. Because it flew in the face of what people want to believe and diminished our ability to loathe and demonize the obese.

So don't expect the results of this new study to change public opinion either. No one is going to introduce legislation demanding that restaurants in Mississippi start supersizing the orders of thin people. But using the logic that has been applies to the obese, they ought to.

I mean, really. Those selfish, costly thin people! . . Why just look at that beanpole there, it's disgusting. He's a stroke just waiting to happen. . . . .