Another Public Health Care Crisis

Obesity is when excess body fat accumulates in one to where this overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as it is of a more serious concern. As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity. Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern.
Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline.
One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine.
Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed. There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.
Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening. So the surgery to correct morbid obesity greatly reduces the co-morbidities associated with this type of obesity problem. Two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur. However, the surgery reduces the mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies.
Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient. Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.
Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.
If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: www.asmbs.org,

Dan Abshear

Cardiovascular disease, I surmise, is very concerning to both those patients who have this disease, as well as others, which include their health care providers. Furthermore, this disease is likely a cause of distress as well as confusion for those professionals who seek the best treatment options for such diseases involving one’s circulatory system, such as hypertension. Hypertension in particular is a frequent medical condition that affects well over 50 million people in the U.S. alone. As a result, there are increasingly many pharmacological options available to delay if not prevent such diseases, and these drugs work in different ways for the same cardiovascular diseases that are acquired often. Many health care providers are understandably unclear as to which treatment option would be most beneficial for their cardiac patient- considering the different classes of medications for cardiovascular disease, and taking into consideration the safety and efficacy of each, which would likely be a difficult task.

As I understand with hypertension, it is very important to control elevations in one’s blood pressure to prevent future cardiovascular events caused by prolonged uncontrolled hypertension in such individuals. Such events include an increased risk for strokes, heart attacks, and kidney failure, among other damage that can be caused in the unmanaged hypertensive patient. While hypertension is evaluated according to different stages of severity, most hypertensive patients have initially what is called primary,or essential hypertension, and this usually requires medicinal treatment to control their high blood pressure.

One significant reassurance that was provided for health care providers was made available regarding which pharmacological therapy for hypertension should be chosen by them for certain hypertensive patients they may have or acquire. This reassurance was due to the results of the ALLHAT trial. This trial lasted 4 years, and was published in the Journal of the American Medical Association in 2002. Also, the trial was conceptualized and implemented by the National Institute of Health during the 1990s. This trial was the largest study to date addressing, among other variables, those patients who were hypertensive. The study thoroughly analyzed and examined which class of medications would be the most effective for these certain patients who were given a selection from these different classes of medications for their hypertension treatment that were involved in the ALLHAT trial.

In addition, the ALLHAT trial included over 40,000 subjects who were over the age of 55 and were evaluated in over 600 clinics during the course of this trial. Nearly half of the patients in this trial had metabolic syndrome, which is a syndrome where one is obese, has dyslipidemia, and glycemic issues as well. While Pfizer financially contributed a small portion to support this trial, ALLHAT was overall funded by the National Institutes of Health at a cost of around 130 million dollars, which again was for the purpose to determine the best medicinal treatment for the patients that were studied in this trial according to the trial’s study plan. This study protocol had not been done in the past, and the comparative effectiveness design strengthened this clinical trial.

Because the NIH did in fact develop and fund this study, the ALLHAT trial, as a result, was largely if not completely void of bias and commercial interference compared with those trials that are sponsored by the manufacturers of drugs studied in other trials often. Because of the ideal design and methodology in which this trial was performed, most concur the results of this trial are quite accurate and valid.

Once again, the ALLHAT trial provided data that allowed a true comparative analysis of these various classes of drugs for hypertension, which included calcium channel blockers, ACE inhibitors, Alpha Blockers, Beta Blockers, and diuretics. The researchers examined the action of these classes of medications on the subjects who possessed various cardiovascular disease states- with a focus on the ability of each one of these different classes of drugs on the disease of hypertension the patients in the study had during the trial. As the trial was completed with data collected and analyzed after a 4 year period, the ALLHAT trial concluded that one particular class of medications involved in this study proved to be the most advantageous for the subjects as it relates to safety, efficacy and cost for those who require treatment for their cardiovascular disease state, as well as the prevention or the delay of progression of additional cardiovascular disease states studied and examined. Amazingly, this one drug class in this study in fact is nearly as old as the subjects involved in the trial.

ALLHAT results specifically and clearly concluded that thiazide diuretics are, overall, the preferred choice of medicinal treatment for initial medicinal therapy with those who are hypertensive patients, as this class of drugs overall proved to be equivalent if not superior in many ways compared with the other classes of drugs in the study. Diuretics offered great protection against cardiovascular disease and controlled hypertensive patients as they needed to be, and proved that diuretics should be the first line drug of choice in such patients. The diuretics also decreased the risk of heart failure and stroke, as well, compared with the other classes of drugs in this trial. Thiazide diuretics were in fact superior in these risk factors in this comparative effectiveness protocol, and just as effective as the other classes of drugs it was compared to in this trial with preventing myocardial infarctions. Thiazide diuretics in fact have been studied in such disease states associated with cardiovascular disease for over 40 years and have shown similar results as were shown in this trial.

This class of medications, diuretics, have been available in the United States for well over 50 years, and presently costs about 25 dollars a year, instead of a few dollars a day for many if not most branded medications for CV conditions that were examined in the ALLHAT trial. So this finding, of course, concludes that diuretics not only provide equivalent if not superior benefits for cardiovascular disease patients, but also provides cost savings as well as illustrated in this trial. Again, the ALLHAT trial was rare and unique in that it compared diuretics to these other classes of medications directly, which is not done frequently with clinical trials involving branded pharmaceuticals, as they usually do comparative studies with simply placebos most of the time, so their efficacy comes into question as a result.

Yet, even though this trial was potentially beneficial for so many who are involved with prescribing medications as initial therapy for their hypertensive patients, the recommendations based on this trial to start a patient on such a diuretic was remarkably not followed entirely if not mostly by those health care providers. There was of course hope and expectation that diuretics would be utilized to a greater degree based on the results of this trial, and the researchers were puzzled that this was not occurring. So much amazement was occurring with these researchers of the ALLHAT trial, they eventuallly implemented what was called an ALLHAT dissemination plan from the years 2003 to 2006 at a cost of close to 4 million dollars. They desired to educate health care providers about the ALLHAT results, and the significance of the findings, the acknowledgement of the benefits of diuretics continue to be unrecognized by health care providers who select other classes of drugs to treat their hypertensive patients, as they still do today. The other classes aside from diuretics do in fact have benefits with cardiovascular patients, with compelling indications in particular. Yet the etiology for the prescribing habits regarding diuretics and why this class of medications is not chosen as often as they should be is largely unknown after several attempts to convince health care providers otherwise.

Others have speculated why this issue with diuretics in the ALLHAT trial never caught the attention to change the prescribing habits of health care providers, overall.
For example, and of no great surprise, these results of the ALLHAT study appeared to be of notable concern to those pharmaceutical companies who promote the other classes of medications in the ALLHAT trial that are more expensive than a thiazide diuretic.

Reportedly, these companies who market these other classes of drugs increased their promotional spending in order to blunt the potential effects this trial may have on the usage of their cardiovascular medications that again belong to the classes that were involved in the ALLHAT trial soon after the results from this trial were published. Sampling of their branded medications to health care providers increased noticeably as well from those pharmaceutical companies that had branded medications for cardiovascular disease states. Thiazide diuretics, while clearly the apex for the prevention and management of hypertension and other cardiovascular disease states, do not engage in this promotional behavior that appears to be more of a powerful force than evidence-based medicine, as with the case of this diuretic and the benefits of this class of drugs that has been discussed.

Furthermore, drugs combining two medications from different classes of medications for hypertension and other cardiovascular disease states are increasingly preferred by many health care providers for understandable reasons presently- depending on the severity of the cardiovascular disease states that may exist, along with the risk of developing these cardiovascular conditions. It has been said that nearly 70 percent of hypertensive patients alone require more than one medication to adequately have their hypertension controlled. It is not unusual, for example, for a branded pharmaceutical company to combine their medication for hypertension with a diuretic for those patients that may have a stage of hypertension that requires simply more than just one drug for reduction of their high blood pressure. On the other hand, some cardiovascular combination medications are absent of a diuretic. Yet diuretics remain the first line choice of treatment based on the results of the ALLHAT trial, regardless, and should be included in any combination drug chosen for the treatment of most cardiovascular disease patients with hypertension that requires more than one drug for control of their high blood pressure, according to others.
More convincing is that the JNC-7, a report that concludes which medication is best for the prevention and treatment of high blood pressure as well as other cardiovascular conditions, concurs with the results of the ALLHAT trial, and as a result, the JNC states in their report that diuretics are preferred for first-step hypertension therapy, and acknowledge that this class of medications is presently under-utilized. The Report is rather thorough, and is developed by the American Heart Association. The report is also recognized and respected by health care providers who treat cardiovascular disease.
I’m comfortable as a layperson in suggesting that the cardiovascular experts should and in fact be obligated to continue to make others aware of the results of the ALLHAT trial, and convince other health care providers that diuretics should be the preferred choice of medicinal therapy for the medical conditions illustrated and treated in the ALLHAT trial.

In particular, thiazide diuretics are most beneficial for those hypertensive patients that are African American, the elderly, obese patients, those with heart failure, or those with chronic kidney disease, others have concluded. And it should be noted that this type of diuretic depletes potassium from the patient taking this drug, so caution should be utilized regarding this issue, as well as the patient who is prescribed a diuretic should be informed of additional possible side effects associated with a thiazide diuretic, although they are infrequent.

Along with the cost savings that could amount to billions of dollars saved annually, diuretic medicinal therapy would ensure both health care provider and patients that they are receiving the proven and ideal treatment which will control their hypertension, and delay the progression and prevent additional cardiovascular events with this particular drug.

Unfortunately, it appears what may be one of the most authentic trials conducted has been and continues to be largely disregarded or not recalled by those who treat hypertension- possibly due to the forces of others whose objectives are of a different nature besides the restoration of the health of others as it relates to the diseases addressed in the ALLHAT trial. So again, it appears in this situation that promotion has been a more powerful force than what science has provided.

Dan Abshear

The Benefits of Generic Medications

More now than in the past, generic medications have been encouraged and selected by prescribers at a much higher rate due to the problem of the high cost of branded meds that many find unfair and unreasonable. Presently, it is believed that over 60 percent of prescriptions written in the United States are now for generic medications. Branded meds are still prescribed often, though, mainly due to samples of such meds provided at a doctor’s office from the sales reps who promote these meds. Generics typically are not sampled due to lack of funds compared with branded pharmaceutical companies. Yet generics cost a small fraction, such as a third of the cost of branded medications in certain cases, and yet are therapeutically equivalent. Yet not all branded meds have a generic formulation due to patent exclusivity and therefore cannot be produced until the expiration of this patent of the branded med.

Considering over 130 million in the U.S. take prescribed medications every month. Nearly 4 billion prescriptions filled every year, cost savings is rather important. Also, over 125 thousand in the U.S. die every year from reactions or mistakes from taking pharmaceuticals. This pharmaceutical industry makes about 3 billion dollars every year in the United States, and this annual amount increases over ten percent every year. Yet generic medications are about two thirds of this total pharmaceutical market with the drugs included in this market, however, while most prescriptions are for generic medications, this still is less than 15 percent of the total money spent on prescription drugs. About 75 percent of the newly approved drugs by the FDA are similar in efficacy as drugs that already exist in this market. Finally, about half of all newly approved prescription drugs have had serious side effects soon after they have been approved, so newer is clearly not always better, of course.

Most recently, certain managed health and prescription providers have been actually paying doctors to initiate if not switch their patients to generic medications, if possible.

This may be due to a reaction caused by branded pharmaceutical companies offering similar inducements, yet the companies paying doctors is remarkably legal, and therefore allowed to occur. Yet I find this process inappropriate and unethical in regards to patient health, as their objective is one of a profit motive more than actual cost saving for the patient.

Not long ago, generic meds were not prescribed that often, or produced to a great degree, because of the cost of bringing such a med to the market, which at the time required the same clinical trial protocols as branded meds. Fast forward to 1984, as this is when the Hatch-Waxman Act was introduced, and this Act only required generic meds to demonstrate bioequivalence to the branded med that they desire to reverse engineer, and nothing else included in the approval process that is required by branded medications to be completely developed and approved by the FDA. This reduced cost of generic manufacturing and approval allowed for more of these meds to saturate the pharmaceutical market, and doctors started prescribing more generic meds as a result.

Branded pharmaceutical companies were not pleased in large part with this new act, so they devised schemes to extent the patents of their branded meds through such tactics as reformulation, which is called evergreening, of their meds, which allows for them to continue the lifespan of their branded medication. Also, such tactics implemented by pharmaceuticals, such as frivolous patent infringement lawsuits, which delays generic availability for a longer period. Also, branded pharmaceutical companies have been known to actually pay generic manufacturers to not release the equivalent of a branded medication.

Yet pharmacies support generic use, as they make more money off of generic prescriptions they fill for others as compared with branded drugs. So delays will not prevent the utilization of generics, overall. Generics seem to remain a concern to branded companies in spite of their efforts of avoiding their access, as branded companies have progressively started producing their own generic meds along with their branded ones due to the increased use of generics, or have acquired generic pharmaceutical companies entirely.

Also, other reasons for increased generic prescribing may be due to the awareness and clinical experience of the previous branded med that has been replicated by the generic medication. Newer drugs at times are not a desirable choice of treatment for patients because of lack of confidence- with possibly safety being the main concern with some prescribers. So the familiarity of a generic equivalent of a known med creates a more reassuring choice for the prescriber. Available generics are listed in what is called an orange book. It should be available to all health care providers for their access. And some studies show that generics are as effective compared with branded medications for particular disease states. The ALLHAT trial showed this, with generic diuretics showed equivalence if not superiority over the branded medications it was compared with during this 4 year trial funded mostly by the NIH.

Most encouraging for even greater use of generic meds is that at least one company has created vending devices for doctor’s offices for dispensing both generic and over the counter meds. This may discourage the use of branded equivalent meds at a greater amount with generic samples available as well as the branded meds. In addition, and in some cases, doctors can order generic samples from the manufacturers. I consider this device rather innovative.

Yet some doctors insist that you get what you pay for, so they are convinced that branded meds are always more efficacious and tolerable than generic meds. This misconception is a fallacy, since both forms are identical from a bioequivalence and bioavailability paradigm, as required for approval. I’m sure it’s possible others have encouraged such doctors to take such a stance void of fact and reason. Yet there may be some truth to decreased efficacy of generic meds over their branded equivalents.

If one considers the health care crisis in our country and the over-priced treatment methods in our health care system, such as with branded pharmaceuticals, generic medications should be considered when clinically appropriate for the benefit of those seeking restoration of their health. It would beneficial for patients to become aware of this pharmaceutical system and request generics when being prescribed a med by their health care provider. In other words, they should question authority figures such as doctors are perceived to be, as patients definitely have a right to acquire knowledge and use this for their benefit with situations as their choices for treatment options, as this will be for their financial benefits while improving their well-being with generic medications- an ideal way to reduce health care costs and improve compliance with their meds because generics are an affordable asset to public health.

“What good fortune for those in power that the people do not think.” --- Adolph Hitler

Dan Abshear

Authors note: What has been composed above is based upon information and belief

Sometimes, Death Is Good

There are a variety of different types of infections one can get from many different sources, yet some are more common than others. If they are not beneficial for your physiology, they all should die.

Strept infections are caused by what are called gram positive bacteria, and are unique that these bacteria grow in pairs. Staph bacterial invasions are gram positive as well, with MRSA microbes being very difficult to treat normally with a patient invaded by this class of bacteria. These pathogenic or disease causing bacteria are the ones of concern.

Some bacteria are harmless and live within us to serve various purposes. There also what are known as gram negative bacteria that have similar dispositions as the gram positive bacteria, yet are treated differently with other classes of antibiotics for medicinal therapy.

Group A strep infections can cause diseases such as strep throat and pneumonia. Since there are several types of strep bacteria, a culture and sensitivity is usually performed to assure the correct antibiotic is selected for treatment, as the bacteria is identified with this method. Typically, fluid from the area suspected of being infected is obtained and smeared on what is called a petri dish. And then these dishes are incubated for 2 to 3 days. Gram positive bacteria stain during this process a dark violet or blue. Gram negative bacteria would be pink in color.

When the culture is complete, technology offers recommendations on the appropriate class or brand of antibiotic for this bacteria present in another person- presuming the bacteria will not be resistant to the antibiotic recommended, as this happens on occasion.

Usually, classes of antibiotics that are used to treat gram positive strep infections are cephalosporins, macrolides, or general penicillins. If the microbe that is causing the infection is resistant to the antibiotic from such classes that are administered to the infected patient, then there are other more aggressive antibiotics that can be chosen for this patient. Such brands for resistant bacteria include Zyvox, which has both IV and oral dosage options. There are also the antibiotics, such as vancomycin or cubicin. However these antibiotics for antibiotic resistant bacteria are given usually due to infections that have progressed to a more serious nature, such as with pneumonia, for example, or osteomyelitis. A hospital stay is usually required with such patients, as the last antibiotics mentioned are given by IV administration initially. There are numerous classes and types of antibiotics available, yet bacterial resistance to most of these remains a concern,

Dan Abshear

Historical Facts Associated With Influenza:

The last influenza pandemic occurred nearly 100 years ago, and this deadly outbreak resulted in about 50 million deaths worldwide. Those who survived have allowed others to obtain antibodies from them to develop other antibodies for future viral outbreaks that may occur. This last influenza pandemic also allowed others to obtain this virus from those who died as a result to facilitate effective treatments and vaccines for viral outbreaks that may happen in the future as well.

With influenza, it is understood that the disease influenza is a disease caused by a RNA virus that can infect both mammals and birds. In fact, this particular virus can mutate to where it can be shared between the two life forms and multiply within each one of them.

Unlike coryza, influenza expresses symptoms more severely, and usually lasts two weeks until one recovers who has the flu. Influenza, however, poses a danger to some with compromised immune systems, such as the chronically ill. In cases such as this, influenza can in fact progress to deadly pneumonia. Symptoms of influenza usually start to express themselves symptomatically 36 hours after being infected with the virus. Over 10 percent of the population are infected with this virus every year- resulting in about 200,000 hospitalizations and nearly 40,000 deaths.

The flu vaccination contains three viral strains of suspected viruses for flu outbreaks during a particular winter season, as determined by the World Health Organization, as well as the Centers for Disease Control, and other organizations. Unfortunately, the influenza vaccine administered last flu season was largely ineffective due to unsuspected strains of the virus infecting others, although about 140 million doses of this vaccine were administered. After giving the vaccination dose to one, it takes about 10 days for that person to build up the immunity for the disease of influenza.

The influenza season peaks between the months of January and March. The vaccine for this influenza season is manufactured by 6 different companies. Yet the strains chosen are speculated influenza viruses, as this does not eliminate the chance of a new and dominant influenza viral strain that possibly could cause a pandemic. It takes manufacturers about 6 months to make and formulate the influenza vaccination. There is a vaccine for this illness that is produced every year according to which type of virus may be prevalent during a particular flu season. The vaccination is recommended to be administered to those who are at high risk, such as the chronically ill. Also, it is recommended that those under 18 years of age get the vaccine, as well as those people over the age of 50. Furthermore, those people who regularly take aspirin should receive the vaccine, as the influenza disease can become a catalyst for Reye’s Syndrome.

Pregnant women should receive the vaccine as well- as there are many other vaccines available to fortunately prevent other diseases, perhaps.

http://www.cdc.gov/flu/weekly/

Dan Abshear