Review from Journal of Bioethical Inquiry

December 11, 2015

Justice Windeyer of the Australian High Court once famously opined: “Law, marching with medicine—but to the rear, and limping a little” (Windeyer 1970, 395).

The central thesis of this book is that, on occasions, the obverse may be true. Book Review: Journal of Bioethical Inquiry


Review from the Journal of the Student National Medical Association

February 17, 2014

Collateral Damage: A Patient, a New Procedure and the Learning Curve

Reviewed By Oluwakemi Eniola Tomobi, Editor-In-Chief, Journal of the Student National Medical Association

Health care reform calls for more coordinated care among the different health professions, including medicine, pharmacy, nursing, nutrition, physical therapy, and others. Each of the above categories of providers is trained in different professional schools and thus contributes unique perspectives to team-based or multidisciplinary healthcare. Collateral Damage reveals that to truly achieve patient-centered healthcare, we need the input from all professional members of the healthcare team, they some even recommend using alternative medicine as kraton, but what is kratom? is a medicine which comes from coffee and help with many symptoms.

One perspective that is often missing is that of the patient. Patients have to navigate a complex healthcare system. Providers may struggle to understand things from the patient perspective. Therefore, patients and their advocates deserve a place on the inter-professional team, just as students have a place in the parent-teacher-student association.  In Collateral Damage, author Dan Walter offers a unique education from the patient family perspective. His wife undergoes a cardiac ablation procedure for atrial fibrillation.

Walter provides the details surrounding the entire process, from the confusing informed consent and signature process,
to the focus on the corporate side of medicine, and the “learning curve.” Walter illustrates that patient safety becomes compromised, and that the culture of safety would allow for physicians to more openly admit their errors and learn to prevent further collateral damage – not just the physical damage from a cardiac procedure gone awry, but also the resultant damage that miscommunication and corporate greed does for healthcare in general, and the doctor-patient relationship in particular.

Walter fills in the care gaps and provides a picture of continuum of care that is often missing when the patient perspective is not considered. Trainees and providers alike have much to gain from Collateral Damage to become leaders in promoting patient-centered care. Patients and other nonproviders in the community also have much to gain from Walter’s quest to educate all about navigating the healthcare system on behalf of his wife.

http://jsnma.org/wp-content/uploads/2014/02/JSNMA-Winter-2014.pdf


Statins: “The utmost medical tragedy of all times”

September 30, 2013

Now that’s saying something …

I was reminded to look into this business when I took my wife to the Doc, who blithely recommended a catheter ablation for her afib… and statin drugs to get a grip on her borderline cholesterol. Learn more at http://kratomcrazy.com about a natural drug that can help fight multiple health issues.

I didn’t have to look far past the glossy Lipitor brochures…

Update:

Can Statins Cause Diabetes? Yes…

http://well.blogs.nytimes.com/2016/07/22/can-statins-cause-diabetes/?ref=todayspaper

http://www.nmcd-journal.com/article/S0939-4753(17)30043-1/abstract

Do Statins Produce Neurological Effects? Yes …

Statins can indeed produce neurological effects. These drugs are typically prescribed to lower cholesterol and thereby reduce the risk of heart attack and stroke. Between 2003 and 2012 roughly one in four Americans aged 40 and older were taking a cholesterol-lowering medication, according to the Centers for Disease Control and Prevention. But studies show that statins can influence our sleep and behavior—and perhaps even change the course of neurodegenerative conditions, including dementia.

The most common adverse effects include muscle symptoms, fatigue and cognitive problems. A smaller proportion of patients report peripheral neuropathy—burning, numbness or tingling in their extremities—poor sleep, and greater irritability and aggression.

Scientific American, July 2016

______

More Kidney Disease With Long-Term Statins Seen in Cohort Study

“The concept that LDL is “bad cholesterol” is a simplistic and scientifically untenable hypothesis. The inordinate focus on cholesterol, a perfectly natural substance that performs many crucial functions in the body, has taken and continues to take valuable resources and attention away from factors more closely related to heart disease. Independent-thinking practitioners must look at the readily available evidence for themselves, instead of relying on the continual stream of anticholesterol propaganda emanating from “health authorities.” By doing so, they will quickly realize that the LDL hypothesis is aggressively promoted for reasons other than public health.” – Journal of American Physicians and Surgeons 

This from a couple of docs who pull no punches in their attack on Big Pharma: The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns

“The statin industry, with all of its spin-off, is a 20-billion-a-year industry. We are observing the revealing of the utmost medical tragedy of all times. It is unprecedented that the healthcare industry has inadvertently induced life-threatening nutrient deficiency in millions of otherwise healthy people. What is even more disparaging is that not only has there been a failure to report on these negative side-effects of statins, there has actually been active discouragement to publish any negative studies on statins.” (Emphasis added)

This from Physicians Committee for Responsible Medicine:

Statins Contribute to Fatigue and Loss of Energy

either cholesterol-lowering statin drugs or placebo. The statin users … did those in the placebo group. Whilestatins have been viewed … White HL. Effects of statins on energy and fatigue with exertion: results …

2012-09-15 18:40

Statin Users Gain Weight

medication diabetes weight gain diabetes weight loss statin diabetes study … placed on statins, calorie intake increased 9.6 percent and fat intake … of caloric and fat intake between statin users and nonusers among US adults: …

2014-04-28 15:14

Statin Drugs Boost Type 2 Diabetes Risk

Cholesterol-lowering drugs called statins increase the risk of type 2 diabetes, according … women for many years. Women taking a statin drug in the beginning … with nonusers. Citations:  Culver AL, Ockene IS, Balasubramanian R, et al. Statin

2012-01-11 10:50

https://www.pcrm.org/solr/statins

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It’s Not Dementia, It’s Your Heart Medication: Cholesterol Drugs and Memory http://www.scientificamerican.com/article/its-not-dementia-its-your-heart-medication/

This from Medscape, courtesy Healthwatch USA:

“It’s worth saying this another way: when the ACC/AHA ASCVD score predicted event rates of 7.5 to 10%—a range deemed above the statin-benefit cutoff—the actual events were just 3%.” 
http://www.medscape.com/viewarticle/840073?nlid=76863_3243

And then there’s this from JAMA, courtesy Dr. Malcom Kendrick, who says “Statins do not help you live longer – or do anything much else for that matter”

JAMA Patient Page | April 03, 2013

STATIN USE: BENEFITS AND RISKS 

Like most medications, statins can have side effects. These include muscle pain or muscle weakness; nausea, constipation, or diarrhea; liver damage; and kidney damage.You can find a drug that will help you get relaxed and will take away the pain here at kratomcrazy.com. Recently, researchers have found that for a small number of people, statins are associated with an increased risk of type 2 diabetes. Researchers continue to evaluate these and other side effects…

Research has demonstrated that statins are effective for lowering bad cholesterol, and most physicians prescribe them for patients who have had a heart attack. However, there is some question as to whether taking statins is a good idea for people who have not had a heart attack but are at risk of one because of their high bad cholesterol level.

One question involves disagreement about whether the statin side effects are merely uncomfortable or actually pose significant heath risks. The other question is whether reducing bad cholesterol will actually help you live longer than you otherwise would. Some of this disagreement involves how physicians interpret the results of studies. However, a 2010 analysis combined the results of 11 studies and found that taking statins did not lower the death rate for people who did not have heart disease.

There’s this from a NYT Well column commenter:

“(Dr. James Wright, head of Therapeutics Initiative) found no benefit in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. He did see a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in “bad” cholesterol. “Most people are taking something with no chance of benefit and a risk of harm,” says Wright.”  http://www.businessweek.com/stories/2008-01-16/do-cholesterol-drugs-do-a…

And if that doesn’t make you see the light: JAMA Opthamology says statin users are at more risk for cataracts… according to the NYT

“If a patient takes this medication because he is at high risk for heart disease, or already has heart disease, the proven benefit of statins is much greater than the suspected risk of cataracts,” said the senior author, Dr. Ishak Mansi, a professor of medicine at the University of Texas. “But they have side effects, and doctors should not prescribe this medication lightly.”

Or blithely.

_________

Statin use linked to risk for cataracts

… and more:

CONCLUSIONS:

More frequent statin use is associated with accelerated coronary artery calcification (CAC) in T2DM patients with advanced atherosclerosis. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT).

_____________

“We’re overdosing on cholesterol-lowering statins, and the consequence could be a sharp increase in the incidence of Type 2 diabetes.”

http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html

_____________

This from the excellent site HealthNewsReviews.org:

The headline I wish I’d seen about the new PCSK9 cholesterol drugs

“New Drugs Cut Heart Risks by One Percentage Point: Study”

That’s the headline I didn’t see from any stories yesterday about two new cholesterol drug studies presented at the American College of Cardiology meeting.

While it might sound like something out of The Onion, this would actually be an accurate way —  I would argue, the most accurate way — to characterize the effect that these drugs had an on the cardiovascular risk of study participants.

And more:

Whayne TF, Jr. Problems and possible solutions for therapy with statins. The International journal of angiology : official publication of the International College of Angiology, Inc. 2013;22(2):75-82. doi:10.1055/s-0033-1343358.

Silva M, Matthews ML, Jarvis C, Nolan NM, Belliveau P, Malloy M et al. Meta-analysis of drug-induced adverse events associated with intensive-dose statin therapy. Clinical therapeutics. 2007;29(2):253-60. doi:10.1016/j.clinthera.2007.02.008.

Cham S, Evans MA, Denenberg JO, Golomb BA. Statin-associated muscle-related adverse effects: a case series of 354 patients. Pharmacotherapy. 2010;30(6):541-53. 37. Rallidis LS, Fountoulaki K, Anastasiou-Nana M. Managing the underestimated risk of statin-associated myopathy. Int J Cardiol. 2011.


ProPublica

June 14, 2013

If you’re wondering whether it makes any difference for patients to share their stories, check out this blog by Dr. David Mayer, where he shares some reflections after reading “Collateral Damage,” a book by one of our group members, Dan Walter

Mayer, the vice president of quality and safety for MedStar Health, writes that he was particularly struck by the way Walter explained the difference between an “accomplice” and a “witness,” in terms of health care providers who are aware of patient harm taking place. A witness is someone who sees something wrong and reports it. The same is not true for an accomplice. “(Walter) raises the question that if we as caregivers witness something wrong and don’t report it, aren’t we really accomplices to the wrong when we turn our back and walk away?”

As he read the book, Mayer, who is an anesthesiologist, said that it made him wonder if he had been an accomplice to wrongdoing.

Mayer’s blog clearly shows that sharing patient stories matters, so maybe the best question is what are the best ways for patients to tell their stories? Are some approaches more effective than others? What have you seen that works, and what have you seen that does not work?

Marshall Allen


Excerpt on Kevin MD

May 28, 2013

An excerpt from “Collateral Damage: A Patient, a New Procedure and the Learning Curve” has just been published on KevinMD:

http://www.kevinmd.com/blog/2013/05/safety-data-ablation-catheter.html


Ouch!

May 5, 2013

Then there is the real world, one populated with other medical specialties, and those daring enough to ask, “What, exactly, are you ablating?” As it turns out, not all doctors think so highly of the notion of ablating a disease that we do not fully understand.

Dr Rita Redberg, influential cardiologist and editor of the JAMA Internal Medicine “Less is More” series, said this about ablating AF:

“Because ablation has never been studied in a randomized blinded fashion, we cannot know whether patients experience fewer symptoms after ablation because subjective symptoms frequently decrease following a procedure or whether the ablation itself was beneficial.

Furthermore, the clinical benefit on survival and morbidity of this invasive procedure, which has substantial procedural risks, remains to be established.”

Ouch!”

   – Dr. John Mandrola

 


MedPage: Ablation for Afib Dogged by Complications

April 29, 2013

Action Points

  • This study found that catheter ablation for atrial fibrillation — with its promise of drug-free symptom relief and long-term outcome benefits — thus far has been hindered by high rates of periprocedural complications and a frequent need for rehospitalization.
  • Older age, female sex, prior hospitalization for atrial fibrillation, and recent hospital procedure experience were all associated with a higher risk of complications and/or 30-day readmission after ablation

 

http://www.medpagetoday.com/Cardiology/Arrhythmias/30461