geoffrey modest medical blogs

This if from Ken Saffier, wanting to add it to the ever-growing Big Pharma Shenanigans blogs on drug company malfeasance and greed. per the NY Times, at the time of the release of these extraordinarily expensive Hep C drugs, Gilead admitted that the pricing was totally divorced from their costs but that the drugs were "worth it" because the costs of Hep C care was even more. this extensive Senate Committee investigation, led by a conservative Republican, confirms this. geoff Senator Ron Wyden Press Release December 1, 2015 Wyden-Grassley Sovaldi Investigation Finds Revenue-Driven Pricing Strategy Behind $84,000 Hepatitis Drug 18-Month Investigation Reveals a Pricing and Marketing Strategy Designed to Maximize Revenue with Little Concern for Access or Affordability Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and senior committee member Chuck Grassley, R-Iowa, today released the results of ...

a couple of concerns about the exercise prescriptions we give patients: how realistic are they are for the elderly; and when older people cannot do the moderate-to-vigorous activities recommended, is there benefit in less aggressive exercise? a systematic review and meta-analysis was recently done to answer these questions (see  exercise elderly brjsportsmed2015  in dropbox, or doi:10.1136/bjsports-2014-094306). details: --9 prospective cohort studies were found, with 122,417 participants (73,745 women and 48,672 men, mean age 72.9, average cohort size 13,602, six cohorts were American/2 from Pacific region/1 Asian, followup of 9.8 years and with 18,122 deaths (14.8%) --they defined 4 activity levels, by Metabolic Equivalent of Task, or MET) minutes: inactive, low (1-499 MET-minutes), medium (500-999) and high (>1000) --results, with inactive being the reference:     ​--low activity had a 22% reduct...

the CDC just released a somewhat encouraging report showing that newly diagnosed cases of diabetes in the US has started to decline (see overall graph below, and the various articles/subgroup analyses at  http://www.cdc.gov/diabetes/statistics/incidence_national.htm  ). a few observations: 1. there seems to be an overall consistent trend to fewer cases since 2009, though the number of new cases is way above 1980 (the age-adjusted incidence in 1980 was about 3.5/1000 and in 2014 was 6.6/1000) and is basically the same as in 2004-5. of note, the criteria for diagnosis of diabetes did change in 2010 to include the A1C>=6.5. no doubt this increased the number of diagnoses of diabetes, so the subsequent falloff may even be more significant. 2. these data includes only those with diagnosed diabetes, and from current epidemiologic studies, it seems that about 25% of diabetics are currently unaware of their diagnosis 3. the age-adjusted incide...

there have been several recent articles on interventions to prevent cognitive decline, including  1. an op-ed piece in the NY Times (see  http://www.nytimes.com/2015/10/25/opinion/sunday/can-you-get-smarter.html?emc=edit_th_20151025&nl=todaysheadlines&nlid=67866768&_r=0 ​ )  . a few of their points, expanded a bit with the references: -- a 6-week on-line study with 11,430 participants trained several times a week on cognitive tasks: there were 3 groups--one with 6 training tasks emphasizing reasoning, planning and problem-solving; another group was exposed to a broader range of cognitive tasks including tests of short-term memory, attention, visuospatial processing and mathematics, as is found in commercially available brain training devices; and a control group who did not do specific cognitive tasks but answered obscure questions using online resources (ie, like Google). They found that each of these tasks improved...

There are several epidemiologic studies suggesting that fructose plays a role in the development of metabolic syndrome, as well as non-alcoholic fatty liver disease, type 2 diabetes, and cardiovascular disease. A small study just came out assessing 43 children with obesity and metabolic syndrome who were put on a 9 day fructose-restricted diet and then evaluated several metabolic parameters ( see  obesity and fructose restriction obesity2015  in dropbox, or doi:10.1002/oby.21371). this diet attempted to match each participant's prior macronutrient intake profile details: --27 Latino and 16 African-American children with obesity and metabolic syndrome (mean age 13.3, weight 93 kg, BMI 35.6) --a child-friendly diet: various no- or lower-sugar added processed foods including turkey hot dogs, pizza, bean burritos, baked potato chips, and popcorn results:     --mean caloric intake was 29 kcal/kg: 51% carbs, 16% protein, 33% fat (...