WDDty e news 26/4/07

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DIABETES DRUG: New health warning over the most-prescribed oral

medication

CANCER: Winning the war, or a skirmish?

BLOOD PRESSURE: It's what your left arm's for

PARKINSON'S: Drugs turn sufferers into compulsive gamblers

BIPOLAR: How can we treat this problem (when antidepressants don't

work)?

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DIABETES DRUG: New health warning over the most-prescribed oral

medication

 

 

There's something very wrong about the world's most heavily

prescribed type II diabetes drugs. They are a family of drugs with

the very long name of thiazolidinediones, which is equalled only by

the length of the list of adverse reactions they cause.

 

The thiazolidinediones are the world's leading oral anti-diabetes

drugs, and doctors regularly prescribe them as a `last resort' drug

when other medications have failed to reduce blood glucose levels.

 

Their heavy use is a puzzle, especially when you consider their

safety record. Back in 2000, Rezulin (troglitazone), a

thiazolidinedione developed by Warner Lambert, was withdrawn from the

American market because it was found to cause liver toxicity. At the

time, two of its rivals – Actos (pioglitazone) and Avandia

(rosiglitazone) – were considered to be safer, and were allowed to

stay on the market.

 

This may have been a mistake, judging by more recent safety reports.

Just last month Avandia was found to dramatically increase the risk

of bone fractures in women, and now researchers have discovered that

Actos has exactly the same effect.

 

Apart from increasing the risk of fractures and liver toxicity,

thiazolidinediones also cause edema, a condition that causes a

swelling or fluid retention in the lungs, and they increase the risk

of heart failure.

 

Despite these concerns, most of which have been known about for some

time, doctors' prescribing of the drug family remains " robust " , as

one researcher puts it, which is more than can be said for the

patient.

 

(Source: Journal of the American Medical Association, 2007; 297:

1645).

 

 

 

 

 

CANCER: Winning the war, or a skirmish?

 

 

Are we finally winning the war on cancer? According to President

George Bush, we certainly are. He paid a special visit to the

National Institutes of Health earlier this year to make the

announcement, based on the " steepest drop " in cancer deaths in the

USA ever recorded.

 

This is wonderful news, and it's true – sort of. In 2004, 553,888

Americans died from cancer, compared with 556,902 deaths the year

before.

 

So, in 2004, there were 3,014 fewer deaths, or a drop of one-half of

one per cent, which is gratifying, but this one year hardly warrants

the crowing from President Bush, oncologists and the American Cancer

Society, a spokesman for which said: " The hard work towards

preventing cancer, catching it early, and making treatments more

effective is paying dramatic, lifesaving dividends. "

 

That's a big and celebratory statement for a one-half of one per cent

reduction. Sadly, cancer deaths have risen or remained roughly the

same for the last 70 years in America, and against that, the 2004

figures look more like a blip than a battle that's being won.

 

Worse, this mutual back-slapping stops the testing of other cancer

treatments, which have shown potential in a series of anecdotal

studies. Instead, it sustains the delusion that the conventional

treatments really are effective, which is sadly only true for some

cancers, and those caught in the earliest stages.

 

(Source: Townsend Letter, 2007; 286: 35-6).

 

BLOOD PRESSURE: It's what your left arm's for

 

 

If you're having your blood pressure taken, always present your left

arm for the cuff. Blood pressure readings from the left arm are

usually lower than from the right.

 

A new study has found that the difference can be as much as 3 mm Hg

between the two arms in a healthy patient. The difference is much

more significant if you have arterial disease.

 

It's already established that blood pressure readings are higher in

the morning, so go to the hospital in the afternoon, offer your left

arm – and you should get that life insurance with no trouble at all.

 

(Source: Archives of Internal medicine, 2007; 167: 388-93).

 

 

 

 

 

PARKINSON'S: Drugs turn sufferers into compulsive gamblers

 

 

Dopamine agonist drugs seem to have a very strange effect on

sufferers of Parkinson's disease – they become compulsive gamblers.

 

More than 7 per cent of sufferers who take the drugs develop the

compulsion, a problem that afflicts just 1 per cent of the general

population.

 

Gambling isn't the only compulsive behaviour pattern triggered by the

drugs. Patients are almost as likely to become compulsive shoppers

or they become hypersexual.

 

The gambling problem is even more prevalent among younger patients

who take the drug, or who take a dopamine agonist and levodopa

together.

 

Doctors are concerned that the many internet gambling sites make it

too easy for their Parkinson's patients to lose a great deal of

money. If family or friends suspect the patient is gambling, the

doctor can change the prescription to just levodopa or some other

drug.

 

(Source: British Medical Journal, 2007; 334: 810-11).

 

 

 

 

 

 

 

BIPOLAR: How can we treat this problem (when antidepressants don't

work)?

 

 

Bipolar disorder is now the sixth leading disability in the world.

It is a chronic and recurring psychiatric disorder that causes

dramatic and sudden mood swings – although depression is the bigger

problem because that is when the sufferer is more likely to commit

suicide.

 

Astonishingly for such a prevalent condition, not one of the 25

standard antidepressants has been approved for use for the disorder,

even though doctors regularly prescribe them to patients.

 

And, according to a new Harvard study, they're wasting their time. A

group of 366 bipolar sufferers were given either a mood stabilizer

and antidepressant, or a mood stabilizer and a placebo – but the drug

wasn't any more effective than the placebo. Levels and frequency of

mania were similar in both groups.

 

(Source: New England Journal of Medicine, 2007; 356: 1711-22).

 

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