Monthly Archives: September, 2010

On Eating..

Now that the month of Ramadhan is over for Muslims (the month when they do not eat or drink from dawn to dusk), there is a tendency for many to do the opposite!

I feel its timely to highlight 2 quotes which come out from my previous blog entries:

“I saw few die of hunger; of eating, a hundred thousand.”

Benjamin FranklinBenjamin Franklin
Yes, the perils of over-eating….obesity,raised blood cholesterol,the surfacing of diabetes…the list goes on.
The second quote (my favorite, but not necessarily those of my doctor colleagues!):
Found on a Hieroglyph, from an ancient Egyptian tomb

“One quarter of what you eat keeps you alive.  The other three-quarters keeps your doctor alive”.

No comments needed here!

HealthAlert(10):Diabetes Drug Banned

The Pill for diabetes, Avandia, had been the subject of several investigations with regards to its side-effects for many years. I had written about it a week or two ago Your Sugar or Your Heart. Its baffling though that the nation that consumes this medication the most fell short of a total ban.

The British Heart Foundation as well as the respected British Medical Journal(BMJ) have called for its ban and the European Union’s European Medical Agency  have introduced an outright ban.  This drug has been blamed by research studies as far back as 2007 to cause heart problems when taken by diabetic patients, but attempts to ban it have been painfully slow. While the FDA acknowledged that the drug led to a higher incidence of heart attacks since 2007,  its advisory panel in July this year stopped short of banning it with a split decision.

Why is the FDA reluctant to impose a ban? One can speculate, but the FDA statement on the matter claimed that there wasn’t enough data to kill a drug which it had already approved for sale. And ordering further studies to boost the data would be unethical, if not criminal. Anyway, the FDA is not known for banning a drug quickly, requiring watertight evidence before doing so (remember Cylert and Fen-Phen?).

For the public, the choice is simple. Stop using Avandia and switch to the myriad of other diabetic medications which are available and much less controversial.

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Choosing To Die..Australia Bans Euthanasia Ad

Take a look at this TV advert..its about a terminally-ill man sitting on a hospital bed talking about the choices he made in life, including the choice to die. But this advert will not see the light of day in Australia where it was made because the regulatory authority which decides what is fit for screening on free-to-air commercial stations has decided that “material which promotes or encourages suicide will invariably be unsuitable for television.”

Australia’s Northern Territory introduced the world’s first voluntary euthanasia legislation in 1995 but it was overturned by the federal government and euthanasia remains a crime in the country. Euthanasia advocates appear unfazed and are pressing for the ad to be released on TV. You decide…

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They Shoot Doctors Too, Don’t They?

..and I don’t mean shooting oneself in the foot, which many people, including doctors may do at some time or other  ;-). Yesterday’s shooting of a doctor by an irate relative in one of the world’s top hospitals, Johns Hopkin’s, has shocked many and raised the call of whether there is adequate security in today’s healthcare facilities.

Johns Hopkins Hospital,Baltimore - scene of the shooting

The Shot Doctor - Dr David Cohen

About the shooting – it appears that the dictum “Don’t shoot me, I’m only the messenger” was not adhered to. It turned out that the assailant had been looking after his bed-ridden mother for months in the hospital and had consented for the mother to be operated on to fulfil her wish to be able to walk again. The operation did not go according to plan and the doctor, an orthopaedic surgeon, was in the process of explaining that she might not be able to walk again when all hell broke loose and he was shot. Later, police found the assailant and his mother both dead, the consequence of a murder-suicide theory.

In actual fact, the shooting incident is on a long list of hospital shootings or attacks on health-workers (see here). It appears that hospitals are fast becoming a hostile environment, not least of which because a large number of people are highly stressed. More than half of the 3,465 health workers surveyed last year by the US Emergency Nurses Association reported they’d been hit, spat on or physically assaulted while on the job.

The high-risk locations in hospitals where security issues are common include:

the emergency/trauma department (gang fights, vendettas, domestic conflicts, child custody conflicts, VIP patients);

infant care area (infant abduction);

pharmacy/drug storage area (narcotic theft);

operating rooms (opportunistic thefts),

psychiatric care area (staff/patient violence);

Could This Be The Scene in Hospitals Next?

Already, in the aftermath of this high-profile shooting incident, there are calls for airport-style screening with metal detectors but this will present a logistic problem, as hospitals have several doors and entrances with a few thousand visitors a day. As it stands, most large hospitals already use alarm systems, access control systems, photo identification, CCTV, two-way voice communications which many consider more than adequate, taking into account also the cost implications.

Perhaps a more practical approach would be to have scenario planning and implementing emergency drills, so that medical staff are better-prepared to handle such emergencies. This appears to have been the case in the Baltimore incident.

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Red Wine – the Good, the Bad & the Ugly

So, is red wine good for you?

The good part relates of course to the much-publicised  high content of polyphenols which originate from the skins, seeds, and vine stems of red grapes. This anti-oxidant comes in two main forms: flavonoids and nonflavonoids, the latter being the one well-known for resveratrol, the substance known to be the found in the skin of the red grape (or for that matter, any of the colored berries, like raspberry,cranberry,blueberry,etc).

Red, Rose or White? Choose Red for Resveratrol

One of most well-documented benefits of red wine is the heart protective effect. Moderate consumption of red wine on a regular basis may be a prevent coronary heart disease, as well as increasing the levels of the good HDL-cholesterol. It is believed the polyphenols as anti-oxidants also prevent plaque formation and clogging of the arteries in the heart, besides having an anti-clotting effect that causes ‘thinning’ of the blood.

And what’s moderate consumption? 2 glasses (1 glass=5 oz=150 cc) for men and 1 glass for women daily.

And what about the bad? Even the Bard knew about this –

‘Alcohol provokes the desire, but takes away the performance.’

(Shakespeare (1564-1616), Macbeth; Act II, Scene 3)

Also, apart from migraine and dehydration (the thirst the morning after), the alcohol in the wine interacts with a lot of medications special warning to those taking tranquillizers and sedatives because alcohol is a downer which adds on to the effects of these pills to cause, in extreme cases, inability to breathe, coma and death. Impairment of attention and skills, including delayed reaction times is a well-known danger for drivers, a fact well-known in causing serious accidents on the road. Temporary amnesia is well-known among boozers, and is best exemplified by UB40’s Red Red Wine:

Red, red wine
Goes to my head
Makes me forget that I
Still need you so

And what about the ugly side of drinking wine? This goes to those who pretend to be wine-buffs and make common mistakes.. such as:

  • mis-pronounciation: saying Pinot Noir and pronouncing the ‘T’. Saying Semillion as it is spelt instead of ‘Seh-Mee-Yhon’.
  • Ignorance: complaining that the waiter didn’t pour them enough wine, when the intention was for them to taste it. Or making it a point that the red wine was too warm.
  • Misplaced beliefs: ordering a bottle of expensive wine just so it looks like they know their wine, when they haven’t a clue what they’re actually drinking.
  • Misplaced practices: vigorously swilling the wine around in the glass to allow it to breathe but then embarrassingly spilling it over themselves. Or (this one takes the cake) complaining to the waiter  that the wine was corked, not realising it came from a screw-top bottle.

At the end of the day, it might help, especially to those who do not touch alcohol, to note that the beneficial effects of red wine comes not from the alcohol but from the skin of the red grape, so it is believed that fresh juices from coloured berries, like raspberry,cranberry,blueberry,etc, may confer a similar effect. Cheers!

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Shake Hands Harder To Live Longer

A recent study in the British Medical Journal was highlighted in most newspapers in a somewhat oblique manner, an example being – “Strength of your handshake may indicate how long you will live” (UK Independent). This is not to mean that we all should make a conscious attempt to try to attain a vice-like grip on everyone we meet! Far from it..

To put the findings in a proper perspective, this study originated from a reliable source, a unit of the Medical Research Council of the UK, involving 50,000 people who were followed up to 43 years. It measured four indices of physical activity:

Grip strength

The Bonecrusher - doesn't always make you live longer

People with the weakest grip had a 67 per cent increased risk of premature death compared with the strongest.

Walking speed

"Look at me..I'm proving the study wrong!"

The slowest walkers were 2.8 times more likely to die than the fastest walkers.

Chair rising

Those who were slowest at getting out of a chair had almost twice the death rate of those who were quickest.

"I'm dying to get out of this chair quickly!"

Standing balance

Standing on One Live Longer?

Capacity for sustained standing on one foot was linked with a lower death rate.

These  four measures are related to a person’s ability to perform everyday tasks, which is of increasing importance in an ageing population. They require strength, balance, muscle power, speed, motor control, mental concentration and adequate heart and lung function. These functions decline with age, contributing to increasing frailty.

This is all very well, but my thoughts are that the one important factor to prolong life that seems to be missing is a person’s will to live. But then does one measure this?

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Your Sugar or Your Heart?

Those familiar with the ongoing debate whether to ban a popular anti-diabetes drug for potentially dangerous side-effects are mostly wondering why its taking the authorities so long to put a ban on it.

Glaxo’s Avandia, also known as roziglitazone, has been blamed by research studies as far back as 2007 to cause heart problems when taken by diabetic patients, but attempts to ban it have been painfully slow. While the FDA acknowledged that the drug led to a higher incidence of heart attacks since 2007,  its advisory panel in July this year stopped short of banning it with a split decision.

Avandia ban - decision to be made by EU September

Health advocates have mounted a strong campaign against Avandia, saying its risks outweigh its benefit. Even a conspiracy theory has emerged – the New York Times this week published documents that it said showed SmithKlineBeecham – the firm’s name in 1999 – buried a disastrous study that suggested Avandia posed greater heart risks than a competing drug. Has Big Pharma managed to buy out the regulators?

Across the Atlantic, the story is clearer – the UK watchdog authority has called today for the withdrawal of this drug across Europe.(here).

And the irony of it all..while we have a diabetic drug that can cause heart attacks, we also have a heart  drug (Crestor) that can cause diabetes!

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An Unwanted Visitor to the Commonwealth Games

When New Delhi opens its doors to athletes at the Commonwealth Games October 3rd, it would have by then encountered innumerable problems leading to the Games.

While China impressed the world with an almost flawless Olympics, India’s has been dogged with inefficiencies and shoddiness. India’s preparations have been hampered by allegations of corruption, mismanagement and inadequate facilities which threaten whether the facilities will be completed in time at all.

Not least of all, the current impasse on the usage of Blackberry messenger in India will add to communication woes and possible chaos should Indian security agencies impose a ban.

Amidst this, an unwelcome visitor has started to make its presence felt – the dengue virus, the cause of dengue fever. Already, 937 cases have been reported in the last few weeks,  a figure which many consider a gross under-estimate due to a deficient reporting system.(Hospital figures estimate more than 2000 cases in what is described as the worse outbreak in 20 years). Part of the reason for this upsurge is the stagnant pools of water surfacing around the construction sites for the various Games venues.

The Aedes mosquito, which carries the Dengue virus, passes it on when it bites into a human.

The outbreak has already struck two top Indian cyclists and is beginning to instill fear among the arriving Commonwealth Games athletes who fear contracting this disease, especially the most severe form which can cause internal bleeding and death. This fear is heightened because dengue has no known cure or antidote, as are most diseases caused by viruses.

Also, the main fear among athletes is that contracting the disease, however mild, might  impair their chances in the forthcoming Asian Games in November, as well as the Olympics in 2012.

Meanwhile, authorities are scrambling to clear the construction sites of stagnant pools and improving the environment so that India’s aspirations of becoming a successful host remains intact.

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