Category: Patients

Was it the sugar or the caffeine?

published date
September 29th, 2006 by

Was it the sugar or the caffeine?

From Reuters, via Mickey:

Oslo teens who drank the most sugary soft drinks also had more mental health problems such as hyperactivity and distress, Norwegian researchers reported on Thursday.

Their study of more than 5,000 Norwegian 15- and 16-year-olds showed a clear and direct association between soft drink intake and hyperactivity, and a more complex link with other mental and behavioral disorders.

For hyperactivity, there was a direct linear relationship — the more sodas a teen drank, the most symptoms of hyperactivity he or she had.

The worst problems were seen in boys and girls who drank four or more soft drinks a day. Ten percent of the boys and 2 percent of the girls drank this much.

The researchers said it was possible that other substances in the soft drinks, such as caffeine, were to blame for the symptoms, and they did not check other possible sources of refined sugar in the children’s diets.

The failure to control for caffeine intake makes it unclear whether this study really demonstrates anything non-obvious. There are anecdotal reports of people who are very affected from non-caffeinated refined sugar products, so the sugar / hyperactivity hypothesis remains a reasonable one. However, studies of large populations have had trouble demonstrating an effect, and this study does not seem to move the ball forward or backward on that question. A possible model for a sugar – hyperactivity link could be yet undiscovered diseases that affect behavior and have a sugar triggers as seen with the muscle disease hypokalemic periodic paralysis.

Police and the mentally ill

published date
September 28th, 2006 by

Police and the mentally ill

A Wall Street Journal article (With ‘Reality Visors’ Officers Try New Tack to Face Mentally Ill) was mainly encouraging. Police are learning to deal effectively and compassionately with the mentally ill rather than using aggressive techniques that are inappropriate and sometimes spark violent reactions. But I was a little surprised to read about what officers in Phoenix are up to:

[Police officers] …conducted home visits with… mentally ill residents to make sure they were attending therapy sessions, getting medical care and taking their medication. They urged the homeless mentally ill to move to shelters and voluntarily accept help for their illnesses… They even drive some patients to doctors’ visits.

Somebody in Phoenix should wake up and hire some psychiatric nurses to do home visits. Using police officers for that job is costly and ineffective.

People are not stupid

published date
September 28th, 2006 by

People are not stupid

A new survey reveals the public’s level of awareness of medical errors and steps patients are taking to prevent errors or mitigate the damage caused:

Substantial numbers of Americans report taking certain actions aimed at improving the coordination of care and reducing the likelihood of a medical error. These include: checking the medication given by their pharmacist against the doctor’s prescription (70%); bringing a list of all their medications to a doctor’s appointment (54%); and bringing a friend or relative to a doctor’s appointment to help ask questions (45%).

These are all excellent ideas and I’m heartened that so many people are taking action. The harder –but even more critical– thing to do is to have an assertive, knowledgeable person who is committed to your health maintaining a vigil at your bedside when you are in the hospital. The survey takers didn’t ask, but I’ll bet a lot of people are figuring that out, too.

Read the full Kaiser Family Foundation/AHRQ survey here.

Finders keepers?

published date
September 21st, 2006 by

Finders keepers?

Last month 230,000 Medicare beneficiaries were accidentally reimbursed for the Part D premiums. The average amount was $215. As I wrote last month:

Unfortunately for the recipients, they’ll have to give the money back.

But not so fast. According to the Kaiser Family Fund, The Center for Medicare Advocacy (CMA) is suing the government.

According to CMA… federal law allows for waiver of recovery of funds when a beneficiary is not at fault in an overpayment. In response to the suit, CMS on Monday agreed to stop mailing letters that instruct beneficiaries to return the money and to remove content on the recovery of overpayments from its Web site.

Medicare recipients are getting an overly-generous subsidy on Part D from the rest of us as it is. Anyone who got the mistaken refund should pay it back instead of taking further advantage of the system. The government should apologize, but that’s it. Meanwhile, shame on the CMA for pursuing this.

I’m upset about the Bextra withdrawal

published date
April 8th, 2005 by

A close friend of mine has rheumatoid arthritis. Under the supervision of her rheumatologist she’s tried all the prescription and OTC options and found that Pfizer’s Bextra –and not any other COX-2 inhibitor or other medication– worked well for her. I know someone else with a similar story about Vioxx.

Yesterday the FDA asked Pfizer to withdraw Bextra from the market. A number of cardiovascular, gastro-intestinal, and dermatological adverse events –some fatal, along with Bextra’s failure to prove its superiority to other treatments, doomed the drug. In an unusual move, the FDA overruled its Advisory Panel, which had recommended that the drug be allowed to stay on the market. The only hope the FDA left for patients who feel they need Bextra was to state that a proposal for a compassionate use program would be received favorably, if Pfizer wants to propose one.

Something’s gone terribly wrong here. The pharmaceutical companies made a big mistake by promoting COX-2 inhibitors to the widest possible customer base. As a result it looks like a number of people who should have been treated with the occasional Tylenol or nothing at all ended up sick or dead. And after the FDA was caught asleep at the switch, it may have overreacted to the latest data. As I wrote last month, J&J is taking the lead in balancing risks and benefits in its direct to consumer advertising –this is in the industry’s own best interest.

I read Marcia Angell’s book, The Truth About the Drug Companies when it came out, and there is a lot of truth in there. But I disagree with one of her main arguments –that me-too drugs (similar drugs in the same class) are bad and should not be allowed. Celebrex, Vioxx, Bextra, and the rest may be quite similar, but for whatever reason each seems to work better in some patients than others. There are similar stories in other drug classes, notably in drugs for depression. It doesn’t matter to me whether the motives of the drug companies are pure; I’d rather have more choice than less.

In 20 years or so, when pharmacogenomics and personalized medicine are the norm, we won’t have to go through trial and error treatment with many different drugs. But for now it’s the best we can do.