Little Black Bag

Zetia Goes Down in Flames

2008-01-14T00:00:00-05:00

A few years back, Zetia came on the market and was going "help reduce cholesterol" for patients who were not at goal despite high doses of Statin therapy. In a brilliant marketing move, the drug companies combined Zetia with Zocor to produce Vytorin, and they put lots and lots of commercials on TV.
Im all for combination drugs. It's always better to take fewer pills but this one is turning out to be a bust.

I was a resident when Zetia came on the market and I remember a teacher who made the comment to me,"sure it lowers cholesterol... but will that actually translate into decreased heart disease?" That always stuck with me and I was determined to avoid the drug until I saw real proof that it improved heart disease. Well, now i'm very happy I was suspicious.

It turns out that Zetia not only did not improve heart disease, it may have actually made atherosclerosis worse. Another unfortunate blow for Merck.

Cholesterol Drug Has No Benefit in Trial

And then of course... will we ever learn? Doomed to repeat history? only time will tell for new drugs.

Genzyme Wins Cholesterol Drug Deal

Looking For A Little Support?

2007-12-31T00:00:00-05:00

I recently found this Site and Thought I would share....

it is a site dedicated to putting like minded people together to form specific support groups. Great idea.
If your looking to talk to someone about a special problem, then give them a try.

dailystrength.org

Better to be Fat and Fit....

2007-12-05T00:00:00-05:00

I for some time now have been telling my patients, "it's better to be Fat and Fit then to be Thin but a couch potato."

I'm constantly trying to educate patients to exercise for the sake of being fit and feeling better, not just to lose weight. Sure, weight lose is a natural byproduct of exercise and healthy eating but that should not be the driving force.

With recent studies suggesting that people with a little extra weight actually having lower all cause death rates

(Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity-JAMA)

and

This study supporting that being fit is more important than actual body weight

(Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults)

I think we may be seeing a shift in American healthcare away from the "Loss weight at all cost" mentality. Constant fad diets and schemes to "melt" away fat abound in our image conscience society. But do they improve our mental or physical health. I just somehow doubt it.

We are physical creatures and before long, hopefully, we will understand the importance of movement and exercise and not worry so much about the extra weight.

Want Your New Mom to Lose that Pregnancy Weight?

2007-11-21T00:00:00-05:00

More reason to support new moms. This is a significant study. fairly well done (although it doesn't address all the variables.) Mom's that don't get enough sleep are 3 times more likely to hold on to the pregnancy weight at one year. Ok dad's, time to strap on those boots and do more 1am baby feedings:)

Sleep Helps New Moms Fit into Their Old Jeans

by Allison Aubrey

Can Green Tea Save Someone from Severe Sepsis

2007-11-10T00:00:00-05:00

Over the last few years new light has been shed on the condition known as sepsis. Sepsis is the term used when someone dies from an overwhelming blood infection. It is extremely common and seen often in the hospital. We previously thought that it was related to toxins produced by the infecting organisms. But new evidence suggest that it is actually caused by an immune response from the body against the invaders. Like an autoimmune disease. Sepsis is hallmarked by blood pressure and cardiac collapse.
This interesting study suggest that a compound in green tea may actually reduce the risk of Sepsis occurring in infected people. This is exciting because to date we have little to nothing to truly treat sepsis.
This is only a study on mice so much more study is needed but I'm encouraged by this.

Green Tea Proves Powerful Medicine Against Sepsis

Are Curves Coming Back?

2007-11-07T00:00:00-05:00

Well, it looks like people are finally realizing that being thin is not actually a healthy thing. go figure....
but it actually goes further than that. just maybe, the scientist have gotten it wrong too?
A recent study shows a lower death rate for people that are over weight (note: this does not mean OBESE (BMI>30.))
The reasons for this are unclear but my guess would be that a little extra energy reserves provides a survival benefit from illness. Again, it is important to note that this was a lower death rate when compared to the "ideal" body weight. Under weight and Obese people still have higher death rates. Also, this study only looked at deaths, not at morbidity (or decreased quality of life that may be caused by excess weight. It's still to premature to make a huge change in our recommendations but this may be the beginning of an upper change in the "Ideal" body weight. Check out these links:

Causes of Death Are Linked to a Person’s Weight: New York Times

Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity- JAMA

"But I dont like taking medicine"

2007-10-19T00:00:00-05:00

It has been brought to my attention once again that the American public has a poor misconception of what is medicine.
Whether it is the "natural" supplements that patients forget to mention to the doctor, or the 7 cups of coffee that the anxiety patient has each day. There is one simple truth about medicine.

It is ANYTHING you put on or into your body for a desired effect.

well, you may say... that seems silly Dr B. think about it.

We take medicine into our body to produce some specific effect.
Water? of course it's medicine. without it we die. We use water to treat people all the time in the hospital. it can even make you sick if you take to much (an adverse side effect.)

Food? almost the same as above. we eat so that we feel good and not hungry. To much and we again, can become sick.

Sun-Tan Lotion? applied to the skin to protect from the sun and prevent aging and burns.

what about the Sun? some people chose to allow the suns rays to enter their body so they can change their skin color or to feel "rejuvenated." But of course, to much and you burn and even can get cancer.

I hope readers can understand. Obviously I have taken this to an extreme, but the point is that we are surrounded by medicine. it is everywhere! And it is silly for us to believe that side effects and adverse reactions are somehow limited to the "medicines" that you buy at a pharmacy.
I encourage people to always consider everything in their lives when they have medical problems. The source of the problem may lay with the simplest and most natural thing in your house.

Remember that everything that goes on or into your body can potentially harm you. Even "natural" things. Rattlesnake poison is natural, doesn't make it good for you!

Only One Probiotic Shown to Help IBS Symptoms

2007-10-16T00:00:00-05:00

There is more and more interest is in probiotics (or "good" bacteria) for different gastrointestinal complaints. Specifically Irritable Bowel Syndrome. A vague and poorly understood condition of stomach complaints. We have been encouraging patients to consume beneficial bacteria, but this is the first good study I have seen on it's benefits.

This study (although a review) is good evidence that Bifidobacterium infantis 35624 (main ingredient in Align(R)) helps with IBS Symptoms.

Review Of Probiotic Trial Research Finds Only Bifantis(R) Able To Claim Efficacy Versus Placebo For IBS Symptoms

The Religion of Medicine

2007-09-17T00:00:00-05:00

On my first day of medical school, the professor walked in and she said, "Despite my best efforts, I know that by the end of your four years here, 75% of what I will tell you will be wrong."

Sobering and terrifying for me on a daily basis.

Once again, I have found a great article written in the New York Times to help me with my thoughts.

Do We Really Know What Makes Us Healthy?

Science and medicine are all to often looked at as "sterile" and absolute. I would like to challenge this assumption. Is Science really all that different from Religion? Religions seek God and choose to do so through belief and faith, avoiding the need for rationality. But what about science? Is science really doing more than just looking for God (or The Answer, if you will.) Instead of blind faith, scientist do this through rigid rationality, but they still MUST have faith. Faith that the universe follows certain rules. Faith that "The Answer" is worth finding. Faith that knowledge will lead them to "salvation" when in actuality it is only going to lead them to more questions (not to different from religion, but that is another topic:)

But what does that mean for medicine?
well, it's back to medicine being an art. Just like traditional art often reflects and commentates on religion, medicine reflects and commentates on science.
We take an immense amount of information and reflect our best guess as to the right answer. But given the sheer complexity and almost infinite variables in our biology and our lives it's a miracle that we get anything correct. Alas, modern medicine (for all it's faults) has been successful. Average life span and quality of life have all risen over the last 50yrs, despite rapid declination of "healthy" lifestyles in America.
Do we know what makes someone healthy? Well.... no. but, we have a good guess and I'm confident our jobs as physicians are to make people comfortable and to help them enjoy their lives. A job that we can do if people have a good relationship with their doctor and faith.
Faith of good intentions and the will to live and be healthy. This is what makes us healthy. (I hope.... :)

We are what we eat.

2007-09-06T00:00:00-05:00

Here is a New York Times article about a recent study performed by the British government.
----------- ---------- ---------- ----------- ----------- ----------
Some Food Additives Raise Hyperactivity, Study Finds
----------- ---------- ---------- ----------- ----------- ----------
This was a high quality study and is good evidence that a diet high in preservatives and artifial coloring leads to more hyperactivity and inattention in children.
Should we all run to our pantries and throw away our junk food? well maybe....
the fact is that moderation is always the key. We would be healthier by eating more vegitables and fruit, but public health evidence suggest that taking ALL preservatives out our food supply would lead to more illness related to consumption of spoiled foods.

The take home message is to reduce and limit. Eat more Fruits and Vegitables.
You may find your childs behavoir and grades improving.

Paleolithic Diet and then some...

2007-09-03T00:00:00-05:00

I found this article today and thought it was interesting.

INTRODUCTION TO THE PALEOLITHIC DIET

Dr. Ben Balzer, family physician

It is interesting because this is a concept that I have thought about for several years and did not realize it officially existed. Despite all the fad diets and different weight loss options that are available, rarely do they look at the basic biology of who we are. We are mammals that were never meant to eat the diets we have today.
Of course, I do believe that even a "paleolithic diet" can be taken to extreme but it's basic principles are correct. We would all likely be healthier if we ate a diet more similar to that of our ancestors.

I would also like to add another caveat. Along with eating less potatoes, grains, and processed foods, I suggest we consider what WORK our ancestors would have had to do to eat. Foods such as fruits and vegetables would have been readily available and fairly simple to obtain. Therefore, we could eat all we wanted. Meats on the other hand would have taken more work. Fish would have been easiest, followed by poultry, and then red meat. A large animal would have only been killed occasionally and red meat eaten rarely. Humans also would have expended huge energy resources to catch their prey. Something we unfortunately no longer do.

Just food for thought. As you eat your next meal, think about what energy might have been used in obtaining that meal. Did you exercise today?