ErinPharm Gazette July-August 2007
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That many individuals are not compliant with prescription schedules is disturbing news. That often they are not even offered appropriate medication is troubling. We should all take a part in changing this situation. It has now become important to ensure that the young and those at risk should receive the Gardisil vaccine injections to protect against the human papillomaviruses that cause genital warts and lead to cancer. In the developing world an inexpensive and easy method of detecting early pre-cancerous cervical lesions offers the means of reducing mortality due to cervical cancer. Both of these are the beginning of efforts to eliminate cervical cancer. Many people who should be taking a statin are not. The current results in reduction of risk of recurrence of colon cancer after surgery, and the large reduction in risk of development of Alzheimer's disease should lead to treatment modalities that improve the health status of many older individuals. The suprisingly unique ability of Zocor to significantly reduce the incidence of dementia and Parkinson's disease, the recent evidence that setting LDL-cholesterol projected levels even lower than now recommended is possible, and the importance of reaching a primary stroke center within the first few critical hours after onset of symptoms even for the older patient are presented here for your examination. As always, a reminder that in reading these pages you have access to information and treatments that most in the underdeveloped world could not imagine let alone dream of attaining.
A review of July-August 2007. A selection of topics.
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This web page is one of a number of ErinPharm web pages designed by me as a synopsis of topics that interest me as well as being a quick reference page for my newsletter subscribers and myself. I have no affiliation of any kind to any pharmaceutical company or medical group. The opinions expressed are my own. I welcome communication and debate. I am an optimist. I look forward to the future with wonder.
August 31, 2007 John L. Fahey johnfahey@tds.net
The Life Extension Foundation
Tremendous strides forward are being made in the treatment of breast cancer. Keep up to date on these advances. Medscape Breast Cancer Resource Center
Keep up to date with advances in the prevention, diagnosis, and treatment of colorectal cancer.
Know about the latest treatment guidelines for addiction.
Patients should know everything there is to know about Gastroesophageal Reflux Disease (GERD)
Advances in lung cancer therapies are moving ahead. Keep up to date.
Leading expert Dr. Mark Freedman presents new perspectives on multiple sclerosis
University of Kansas research scientist, Dr. Ann Manzardo, is exploring the link between thiamine deficiency and a genetic predisposition to alcoholism.
The first comprehensive map of Genomic copy number variations has been developed. Such copy numbers influence genetic diversity and susceptibility to disease.
Are you trying to lose weight and have been misled by the multi-billion dollar industry selling pills, potions, and 'magic cures'? You are not alone. A survey backed by a commercial drug company reports that approximately 70% of American dieters have tried scientifically unproven methods to lose weight. That's an astounding number of people who have tried dietary supplements in the form of pills and powders. About half of survey respondents incorrectly think supplements are approved by the federal Food and Drug Administration, while about two-thirds believe such products must carry warning labels for side effects. All that happens is maybe temporary loss of weight and the emptying of your pocket. Resist the temptation to believe in those seductive commercials. The only way you can lose weight and keep it off is by a commitment to a change in lifestyle. I recommend lifestyle changes. For more about companies who will help you with lifestyle changes look near the end of the index page for ErinPharm. Index page.
The American Cancer Society is your main source of information in the ongoing battle against cancer.
It is troubling in this age of medical discoveries that there is an urgent need to implement strategies to promote the importance of adherence to medication schedules by the patient population. The National Council on Patient Information and Education has taken the lead in convening a panel of advisors from prominent professional societies, voluntary health organizations and patient advocacy groups to produce a blueprint for action. The facts alone are disturbing. Regardless of age, gender, or socioeconomic group, poor compliance with medication instructions affect all and are particularly of concern for older people with chronic conditions. The report states that almost 29% of patients do not complete the full course of medication, 24% take less than the advised dose, 49% had forgotten to take a prescribed medicine, and 31% had not filled a prescription they were given. All of us could take part in making this part of conversation and in paying particular attention to the elderly.
In an interesting report presented by lead author Dr. Daniel Anderson, from Regions Hospital, In St. Paul, Minnesota, at the recent American Society of Clinical Oncology 43rd Annual Meeting, investigators have found that a retrospective study shows that patients taking a statin have a much reduced possibility of recurrence of colon cancer after surgical removal of the cancer. This is another step forward in confirming other studies indicating that those taking a statin have a reduced incidence of various kinds of cancer.
Findings published in the American Journal of Cardiology, July 1st, establish that patients with preexisting peripheral artery disease or a history of stroke have worse outcomes after acute coronary syndrome. Using data from a multinational registry, Dr. Debabrata Mukherjee, from the University of Kentucky, Lexington, notes that although appropriate use of medications decreases the risk of death in the six months after discharge by 19% and also reduces the risk of death/heart attack/stroke by 12% fewer than half of the patients received all the indicated therapies. ErinPharm agrees with Dr. Mukherjee that physicians have, and should seize, this opportunity to aggressively treat the patient's underlying atherosclerotic process through lifestyle modifications and effective pharmacological therapies.
In a suprising and very welcome research report it has been found that Zocor (simvastatin) is unique among the statins in being linked to a 50% reduction in the incidence of both dementia and Parkinson's disease in patients who have taken the medication for more than 7 months. The principal investigator, Dr. Benjamin Wolozin, from Boston University School of Medicine in Massachusetts, suggests that brain penetrant statins are more effective at preventing neurodegenerative disease than statins that do not. This study used the Decision Support System database of the US Veterans Affairs medical system containing data on 4.5 million subjects.
A simple and very inexpensive test that could be done by health care workers can detect the early stages of cervical cancer and has the potential of reducing cases by a quarter, thereby saving millions of women in the developing world. Researchers from the International Agency for Research on Cancer, in France, and their colleagues in Tamil Nadu, in India, used the technique to screen 49,311 women. This is a landmark study. It represents 25% less incidence of cervical cancer and a 35% lower death rate among those women screened.
Encouraging news for those on aggressive statin therapy who experience a lower than objective LDL-cholesterol level is that the results of a new study show that extremely low LDL-cholesterol levels are safe and may lead to improved survival. The lead investigator, Dr. Nicholas Leeper, Stanford University School of Medicine, California, and his colleagues, report in the July 30, 2007, issue of Circulation that 6,000 consecutive patients, average age 65, approximately half with diabetes mellitus or ischemic heart disease, were followed for a median follow-up of two years. Statin therapy took these patients below an LDL-cholesterol level of 60 mg/dL with a reduction of 35% in the risk of death. The lower mortality was observed across various subgroups, including a 42% reduction in total mortality among those treated with a statin at baseline, a 49% reduction among those with LDL-cholesterol levels less than 40 mg/dL, and a 42% reduction among those without ischemic heart disease. There was no increase in adverse events, no rhamdomyolysis was reported, no risk of elevated liver enzymes, and no increase in risk of malignancy or renal insufficiency (issues currently under investigation by other groups as potential hazards that could be associated with treatment to extremely low LDL-cholesterol levels).
A study on 112 patients with coronary heart disease by Dr. Cheuk-Man Yu, Chinese University of Hong Kong, has shown that intensive (80 mg daily) treatment with Atorvastatin (Lipitor) brought a significant reduction in carotid artery plaque.
Note by ErinPharm: Pomegranate juice, 8 oz daily, is reported to also reduce carotid artery plaque.
Gardisil vaccine, in preventing the genital warts that lead to cervical, vaginal, vulvar, and anal cancer, is overwhelmingly effective. Vaccine effectiveness in the 7,899 protocol participants, women who took all three doses of vaccine and who were confirmed seronegative for human papillomavirus types 6, 11, 16, and 18, reached 100%. Three year follow-up data was presented at the 17th Meeting of the International Society for Sexually Transmitted Disease Research August 1, 2007. Thus the approval of Gardisil by the FDA in June 2006 marks a landmark in the beginning of the elimination of cervical cancer. Dr. Kevin Ault, Associate Professor of Obstetrics and Gynecology at Emory University in Atlanta, Georgia, has presented irrefutable evidence that a national campaign to ensure vaccination of the young and those at risk is essential. Dr. Jeanne Marazzo, medical director of the CDC-funded sexually transmitted disease-HIV prevention center in Seattle pointed out that the duration of the antibody response is the next topic of investigation. That, of course, is the reason for continuing follow-up of those vaccinated.
A dramatic description of the course of events for an 83 year old woman who suffered a major ischemic stroke when at her dinner table and was fortunate in that her husband immediately called the emergency medical services who rapidly and effectively transported her to a primary stroke center where she received tissue plasminogen activator (tPA) at 1 hour 54 minutes after symptom onset, followed by endovascular thrombectomy with recanalization achieved at 4 hour 51 minutes after stroke onset.. Consequent treatment and management highlights the current capability of co-ordination between multiple levels of care providers and an accessible stroke center with 'state-of-the art' facilities. The woman was transferred to an inpatient rehabilitation unit for ten days, after which she was discharged and went home. Her improvement was dramatic relative to her initial presentation and her stroke scale score had decreased from 24 to 4, indicating she was left with a mild residual neurological deficit. This is a message to all of us, no matter what age, that we should write down a strategy, with the location of the nearest primary stroke center, for ourselves, our family, and our colleagues in the workplace, to reach the primary stroke center within the critical first few hours of stroke onset.
MRI is better than mammography at detecting early stage breast cancer. This publication presents the current results and debate in which MRI is clearly superior to mammography but future strategems may well lead to both MRI plus mammography for greater effectiveness in breast cancer detection.
Accumulating evidence points toward a beneficial role for statins in stalling the development of Alzheimer's disease with this presentation that individuals who had been on a statin regimen for at least six months had a 79% reduction of risk in the development of Alzheimer's disease.
In provocative data analyzed for obese patients with diabetes undergoing bariatric surgery for weight loss it was found that the diabetes completely disappeared in 77% of the patients and was resolved or markedly improved in 86%. There are plans for clinical trials in the USA, UK, and other countries to establish this data.
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