geoffrey modest medical blogs

As an addition to the long list of prior blogs on drug company malfeasance (see link at end), there were a couple of relevant articles recently (since I have not railed against drug companies for awhile) 1. the Office of the Inspector General of US Dept of Health and Human Services released a 13-page report on dramatic increases in Medicare spending on meds (see  http://oig.hhs.gov/oei/reports/oei-02-16-00290.pdf  ), with my commentary embedded in the major points: --Medicare spending for Part D increased at $10 billion/yr  from $51 in 2006 to $137 billion in 2015  (and $16 billion just from 2014-15).     --one issue to me is that though Part D is a great help to many people (over 40 million beneficiaries in 2014), it was constructed by Bush to funnel the drug benefits through commercial pharmacies. And this is despite the fact that the feds have access to really cheap drugs (the cost of many generics ...

Yet another study found an increase in heart disease in people exposed to air pollution/fine-particulate matter exposure (see  cad air pollution lancet2016  in  dropbox , or doi.org/10.1016/ S0140-6736(16)00378-0). details: --6795 participants. aged 45-84, enrolled in the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) from 6 different US cities (Baltimore, Chicago, LA County, New York City, St Paul, Winston-Salem) --median age 62, 53% women, 39% white, 12% Chinese, 27% black, 22% Hispanic), 50-80% with at least some post-high school education, 15% smokers, BMI 28, 45% with hypertension and SBP 128 mmHg, 12% diabetic, 15% on statins and cholesterol/HDL/LDL=190/50/115 --followed 10 years with repeated measurements of coronary artery calcium by CT (CAC score) as well as carotid artery intima-media thickness (CIMT); concentrations of fine particulate matter (PM 2.5 , which refle...

There was a recent CDC evaluation of the effectiveness of the live attenuated flu vaccine (LAIV), finding essentially no protective effect last year (see  http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html     ). results: --in May, the CDC found preliminary data of vaccine effectiveness for those 2-17 yo:     --LAIV: 3% (CI: -49 to 37%), so  no significant effect !!     --inactivated influenza vaccine (IIV): 63% (52-72) effective --bottom line: " CDC’s Advisory Committee on Immunization Practices (ACIP) today voted that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine,  should not be used during the 2016-2017 flu season " --the annual flu vaccine for anyone >6 months old should be one of the shots: the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) commentary: --there has been a pretty consistently poor showing...

A working group of the  International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, reviewed data on the relationship between caffeine as well as   hot beverages with cancer , finding that caffeine is good but hot beverages bad ( See  coffee not carcinogenic lancet onc2016  in  dropbox , or  doi.org/10.1016/S1470-2045(16)30239-X). the full Monograph is in press, but Lancet Oncology published a summary. details: caffeine had been listed in 1991 as "possibly carcinogenic to humans" based on limited data of ?increase in bladder cancer. but:     --bladder cancer: newer, better data (>1000 observational and experimental studies) suggest that there is no consistent relationship, and raised the concern in older studies of potential confounding from cigarettes or occupational exposures.     --liver cancer: the...

1. A recent study   found that Tai Chi was at least as good, and sometimes better, than physical therapy (PT) for patients with painful knee osteoarthritis, OA ( see  knee arthritis tai chi vs PT AIM2016 ​ in dropbox, or  doi:10.7326/M15-2143 ). There have been some earlier studies finding efficacy of  Tai Chi  for knee osteoarthritis, rheumatoid arthritis, and fibromyalgia, by decreasing pain and improving physical and psychological health. The current study compared  Tai Chi  with PT. details: --204 people with symptomatic knee OA --mean age 60, 70% women,  53% white/35% black, BMI 33, duration of knee pain 8 years, mostly moderate radiologic OA (Kellgren-Lawrence grade 2 in 38%, 3 in 37%), 50% hypertensive, 20% diabetic, mean WOMAC pain score (Western Ontario and McMaster Universities Osteoarthritis Index) 253 (range 0-500) --interventions (patients allowed to continue meds, including acetaminophen and NSAIDs...

Analysis of the Nurses' Health Study found a significant increase in cardiovascular disease in those with migraine (see  cad and migraine in women bmj2016  in  dropbox , or  http://dx.doi.org/10.1136/bmj.i2610  ). details: --115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease were followed from the prospective Nurses' Health Study II (from 1989-2011) --mean age 35; BMI <25 in 68%, 25-30 in 19%; history hypertension 6%, hypercholesterolemia 12%, smoking 14%; no alcohol in 38%, up to 15 g/d in 58%; oral contraceptives in 12%. --17 531 (15.2%) women reported a physician’s diagnosis of migraine (though no data on presence of aura, migraine frequency, or migraine meds) --women with migraine were more likely to have hypertension, hypercholesterolemia, family history of MI, BMI>30 or be current smoker --Results:     --1329 major cardiovascular disease events...