Tainted drugs the other side of the Chinese equation

Not having it both ways in the cost-savings game. Big Pharma goes and runs clinical trials with the Chinese poor at a fraction of the cost of running them in the US. US companies save tons of money, and Chinese medical staff appreciate the training they end up receiving during such trials.

But the other side of the coin is that saving money can introduce risks. Chinese doctors are often so overstretched they don't have time to do clinical trials well. Inadequate drug testing can lead to importing impure drugs like the tainted heparin that recently killed 80-plus people in the US. Workloads that are too high facilitate mistakes in any country. The margin for error increases all around.

So, are we going to halt the process of globalization of the drug and clinical trial practices? Hardly. It seems it's one of those times in history when, as in previous ages, medical science in the cities and medical centers may be discovering new approaches and solutions, but the benefits don't filter out to the rural areas until much later. There will be cost benefits and lives saved, but there may be surprising losses as well.

Patients don't always receive all standard accepted treatments

Interesting to learn that during a certain period (1997 to 2000), many hospitals were giving at least some of the accepted treatment options for brain tumor cancers (gliomas). But according to a 2005 report on the National Cancer Institue's site, many of them either didn't know about the rest or were simply not delivering them.

Communication in today's world is so easy. But it still requires that the recipient have the time and energy to pay attention to the communication and then do what's required. Often easier said than done. And whole countries can be guilty of missing the boat... Saw a post today on the Mesothelioma Advice blog that indicated Korea just began publicly recognizing the dangers of asbestos last year--after decades of other countries' publicly banning its use.

At any rate, a recent clinical trial is testing a new approach for treating gliomas--injecting a drug candidate called Cintredekin Besudotox directly into the brain via catheter. Early results are promising for extending lifespan. We trust that if this new drug passes FDA testing it will be added to the standard regimen at all cancer facilities.

Is the Emperor naked? National dietary guidelines called to account

When the government speaks, people listen. Well, even though they may not necessarily do everything it says, they--including many family doctors--do take the principles to heart. So the flip-flop of that ubiquitious "National Dietary Guidlines" triangle from top-heavy with meat and protein back when baby-boomers were flooding the world, to today's somewhat inverted version stressing healthy carbs and low fat (hmmmm...how many of the dietary guideline formulators are boomers and how many are Gen X, Gen Y?), does that mean healthy eating has changed? Or does it mean the government doesn't actually know? A couple of docs writing in the New England Journal of Medicine posit that the real situation is that the government doesn't know--and that that's okay. But that they shouldn't, then, be issuing guidelines that many people will follow.

Seems like a no-brainer, doesn't it? If you don't know for sure, you don't pontificate on the subject. But that's not the way the human mind and heart work. When your "subjects" look to you for guidance, you tend to really want to give it to them--to have them see you as strong and wise. And if you don't give it to them, they tend to get very nervous and insecure. So the temptation for you, the emperor, is to just make your best educated guess. Read the story here:National Nutrition Guidelines worthless?

Exhaled nitric oxide real clue to symptoms in mitral stenosis

Patients with moderate to severe mitral stenosis (calcifiation of the mitral valve generally precipitated by an earlier case of rheumatic fever) experience varying levels of inhibition in their breathing and exercise abilities. But sometimes patients exhibit symptoms that are more severe than the level of stenosis indicated by a regular echocardiogram would warrant. In this study, researchers used cardiopulmonary exercise testing and measured exhaled nitric oxide to try to uncover reasons for the discrepancy. By measuring nitric oxide output both before and after exercise, they found nitric oxide has a significant role in regulating the tone of the patient's pulmonary cardiovascular system, and thus the pressure within the heart.

So if you have mitral stenosis and you feel worse than your doctor says you should, ask him/her about doing an exercise stress test. You don't want to submit to open-heart surgery unless it's absolutely called for--and this may be a way to tell.

Forwarding email jokes good for health?

I couldn't resist this one. Seems a recent study has show incontrovertibly that the mere anticipation of having a laugh reduces stress hormones. In their earlier work, the same researchers had found that just thinking of laughing increased health-protecting hormones like endorphins (that alleviate depression) and human growth hormone (that boosts immunity).

So now you know when a trainer comes in and tries to get people to laugh, or a politician has writers put lots of funny stuff into a speech, it's not just about "breaking the ice"---participants who are less stressed will literally react more openly to what's presented. What's more, and of course this is my extrapolation, people receiving email jokes at work can be expected to experience these little boosts in good stuff and reductions in bad stuff---which is bound to contribute to increased productivity, despite the few minutes used "non-productively" to review the jokes.

Anyway, here's the study, so you can draw your own conclusions.