The Daily HIT

All health practitioners have seen patients who develop a dependence on prescription anti-insomnia medications. This apparent increase in mortality risk, however, comes as a surprise.

The usual caveats apply, in that this study does not prove a cause-and-effect relationship. However, the researchers quoted in this MedPage article seem quite concerned.

The use of hypnotic sleep aids was associated with a three- to five-fold higher mortality risk compared with the risk for nonusers, even when the prescription was for a small number of pills, investigators reported.

A prescription for 0.4 to 18 doses per year was associated with a mortality hazard ratio of 3.60 compared with patients who had no prescriptions for hypnotics.

The hazard jumped to 5.32 for patients prescribed more than 132 doses a year, investigators reported online in BMJ Open.

“Rough order-of-magnitude estimates … suggest that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the U.S. alone,” Daniel F. Kripke, MD, of the Scripps Clinic in La Jolla, Calif., and co-authors wrote. “From this nonrandomized study, we cannot be certain what portion of the mortality associated with hypnotics may have been attributable to these drugs, but the consistency of our estimates across a spectrum of health and disease suggests that the mortality effect of hypnotics was substantial.”

Patients who used hypnotics most often also had an increased risk of cancer, with an overall cancer increase of 35% among those prescribed high doses.

 

After waiting several years until the furor died down, it appears that the drug companies and those they fund have decided that the time is ripe to walk back the decision to sharply curtail use of hormone replacement therapy. That decision was based on the landmark 2002 Women’s Health Initiative findings that showed an increased risk of heart disease from HRT, in contrast to previous claims that these medications would decrease heart disease.

See if you can read this article without spotting the not-so-hidden hand of Big Pharma lurking in the shadows. If you arrive at the end of the article without finding it, be sure to read the conflict-of-interest disclosure at the end of the piece.

Menopausal hormone therapy doesn’t have to follow “the lowest dose for the shortest time” strategy for all women anymore, the North American Menopause Society said today.

The group endorsed a flexible approach to duration that takes into account the type and timing of therapy and individual patient characteristics in a statement in its journal, Menopause.

For women in their 50s, the absolute risks are low; younger women without a history of breast cancer can use replacement hormones at least until the normal menopause age around 51, and longer if needed for symptom management, according to the guidelines.

“No ‘one size fits all’ approach is acceptable anymore,” JoAnn E. Manson, MD, DrPH, NCMP, of Harvard, and president of the society, said in answer to a query from ABC News and MedPage Today.

Manson’s position is somewhat surprising since she was a principal investigator for the Women’s Health Initiative, the landmark randomized trial that derailed the hormone therapy movement when it reported a link between Premarin (estrogen/progestin) and increased risk of breast cancer and thromboembolic conditions.

As an organization, “NAMS has close ties with industry, which provides grant support for the organization, advertises in its journal, pays annual dues, etc.,” noted Diana Zuckerman, PhD, president of the D.C.-based National Research Center for Women & Families Cancer Prevention and Treatment Fund.

The new guidelines loosen up on timing, agreed Michelle P. Warren, MD, NCMP, of Columbia Presbyterian Medical Center in New York City, who was also involved with the guidelines.

Women who need hormone therapy can use it for as long as needed, she said in an interview.

That shift should be reassuring for many women, Manson suggested.

After reading the conflict-of-interest disclosures about drug company funding, are you feeling reassured?

A reminder that low-tech procedures have great value.

As the WSJ reports today, British researchers showed that by systematically collecting detailed family history from patients, they boosted the number of patients at high risk for heart disease detected by standard assessment tools from 12% to 18%. Catching more high-risk patients would mean doctors could better steer preventive care that could avert heart attacks.

“In the genomic revolution, we’ve forgotten basic family history as a tool,” says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and the president-elect of the American Heart Association. “I practice genetic epidemiology and look for genetic markers, but by far, the most important thing we can do in the prevention of heart disease is to identify family history,” says Arnett, who was not involved in the latest research.

The study, published today in the Annals of Internal Medicine, pushed patients to fill out detailed questionnaires — which asked, for instance, the age relatives suffered heart disease — and went far beyond the checked boxes most patients would recognize from doctors’ waiting-room forms.

Other research has verified that certain types of family history, such as a parent who had a heart attack before reaching age 60, increases a patient’s heart disease risk by as much as 50%. Probability remains the best tool most doctors have to work with.

I first learned of the Heart Attack Grill from a student whose hometown was Chandler, Arizona, site of the original location of this enterprise. Here’s the Wikipedia entry for this iconic part of Americana.

And now, not for the first time, a national news story highlighting one of the ways that this burger joitn livbes up to its hard-to-forget name.

Menu warnings nearly proved true for a man at a downtown Las Vegas restaurant that offers “Bypass” burgers, “Flatliner” fries and free meals to people over 350 pounds.

Amateur video shows a man being wheeled out of the Heart Attack Grill on a stretcher after a medical episode that restaurant employees said looked like, well, a heart attack.

Eatery owner Jon Basso told KVVU-TV FOX5 he thought it was a joke when a waitress told him a customer eating a Triple Bypass burger was sweating and shaking.

It was a heart attack. He’s recuperating.

A heartening NPR story that reports on a study in the current New England Journal of Medicine:

Maricle had difficulty walking upstairs, downstairs, to the car or down the street. So it’s no wonder that, when she heard about a new study at the nearby Oregon Research Institute to look at the potential benefits of tai chi for Parkinson’s patients, she jumped at the chance. Hoping for help but also loving all things Chinese, Maricle saw the study as a perfect fit for her.

The study, which appears in the current New England Journal of Medicine, was headed by research scientist Fuzhong Li, who practices tai chi himself. Tai chi is sometimes described as “meditation in motion,” because it promotes serenity through gentle movements, connecting the mind to the body. It has been shown to help with loss of balance during normal aging and can help relieve stress. Typically, the positions and postures of tai chi involve slow, focused movements that flow from one to the next.

In the study, Li divided Parkinson’s patients into three groups. One group did resistance training with weights. Another, stretching classes. And the third took up tai chi. Each group participated in a 60-minute class twice a week for six months.

When they finished, Li found that the tai chi patients were stronger and had much better balance than patients in the other two groups. In fact, Li says their balance was “four times better than those patients assigned to the stretching group and about two times better than those in the resistance-training group.”

That led to significantly fewer falls for patients in the tai chi group. Maricle says that before tai chi, she would lose her balance eight to 10 times a day. Now it hardly ever happens. She recently even saved herself from what would have been a sure fall before tai chi. It was raining and dark, and she tripped on the curb as she got out of her car. She was able to hop onto the curb and steady herself.

Whenever there’s a meaningful, health-affirming decision made by any group in the public or private sector, it deserves to be celebrated.

From an Associated Press wire story in today’s Washington Post:

WASHINGTON — Hold the mystery meat: Military bases will soon be serving more fruits, vegetables and low-fat dishes under the first program in 20 years to improve nutrition standards across the armed services.

First lady Michelle Obama and Pentagon officials planned to announce the effort Thursday during a visit to Little Rock Air Force Base in Arkansas, where the military has been experimenting with the idea through a pilot program designed to improve the quality and variety of foods served on base.

…

The Department of Defense considers obesity not only a national problem, but a national security issue,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs. “About a quarter of entry-level candidates are too overweight to actually either enter the military or sustain themselves through the first enlistment.”

The Pentagon spends an estimated $4.5 billion a year on food services, and $1.1 billion a year on medical care related to excess weight and obesity.

Under the Military Health System’s new obesity and nutrition awareness campaign, more fruits, vegetables, whole grains and lower-fat entrées will be coming to the 1,100 service member dining halls in coming months. Healthier choices will be turning up in base schools, vending machines and snack bars, too.

Last week, efforts by some Australian scientists to pressure universities in that nation to eliminate complementary and alternative programs garnered wide press attention. Some Australian universities offer degree programs in chiropractic, osteopathy and acupuncture and Oriental medicine.

In today’s New York Times, the first story I’ve seen wherethe universities reply:

Macquarie University, which is in Sydney and offers bachelor’s and master’s degrees in chiropractic science, said it offered rigorous, high-quality courses.

“Our chiropractic science students are well trained in the fundamental relevant sciences (physiology, anatomy, biochemistry, biophysics, radiology, etc.) together with units in chiropractic methods and clinical practice,” the university said in a statement. “Our students are taught to understand that science proceeds only on the basis of evidence. We are confident that our graduates have been taught those techniques that are known through science to be beneficial.”

Nick Klomp, dean of the science faculty at Charles Sturt University, in Wagga Wagga, New South Wales, said while Friends in Science in Medicine made some valid points, the degree offered at his university, a bachelor of health science (complementary medicine), was based on science.

He said the course was designed to impart evidence-based science to people who already had a qualification, like a diploma, in alternative health care. The course includes such subjects as biology and physiology.

“They’re all subjects that are already mainstream, hard health science subjects,” Mr. Klomp said.

He said that thousands of practitioners were already providing alternative medicine and that there was much demand for their services.

“I could ignore them or I could train them better,” Mr. Klomp said, adding that a majority of the university’s students were already practicing. “We actually create graduates who are much better health care providers. It’s all about evidence based, science based.”