July 18th, 2011 by Elaine Schattner, M.D. in Opinion, Research
Tags: Avastin, Breast Cancer, Cancer Treatment, comparative effectiveness research, Empowered Patient, Evidence Based Medicine, Informed Consent, Larry Husten, Medical Journalism, Medical News, Medical Science, Patient Advocates, Patient Voices, Policy
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Yesterday’s post was not really about Avastin, but about medical journalism and how patients’ voices are handled by the media.
L. Husten, writing on a Forbes blog, cried that the press fawned, inappropriately, over patients’ words at the FDA hearing last week, and that led him to wonder why and if journalists should pay attention to what people with illness have to say, even if their words go against the prevailing medical wisdom.
There’s a fair amount of controversy on this. For sake of better discussion in the future, I think it best to break it up into 3 distinct but inter-related issues:
1. About health care journalism and patients’ voices:
A general problem I perceive (and part of why I started blogging) is how traditional medical journalists use patients’ stories to make a point. What some of my journalism professors tried to teach me, and most editors I’ve dealt with clearly want, is for the reporter to find a person with an illness, as a lead, and then tell about the relevant news, and provide some expert commentary – with at least one person speaking on each “side” of the issue, of course – and then end the story with some bit about the patient and the future.
I argue that this form of medical journalism Read more »
*This blog post was originally published at Medical Lessons*
July 18th, 2011 by John Mandrola, M.D. in Opinion, Research
Tags: A Fib, Andromeda, Athena Trial, Atrial Fibrillation, Cardiac Electrophysiologist, Cardiology, Death, GI adverse effects, Heart Health, Hospitalizations, Liver Failure, Multaq, Sanofi-Aventis, Side Effects
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What should I have told the doctor who recently asked me about dronedarone (Multaq)?
“Supposedly, it’s [Multaq] just like Amiodarone, but without the side effects?” he asked.
Gosh…Should I, or shouldn’t I?
I took a big cleansing breath, reminding myself to stay civil, as at least Sanofi-Aventis, the makers of Multaq, sponsor a cycling team. Then I gave him my long answer:
I started with the fact that Multaq barely made it through the approval process. One of the original studies with Multaq (ANDROMEDA), a randomized trial of Multaq in patients with severe heart failure, showed that patients who took the drug were twice as likely to die.
Multaq eventually won approval for use in patients without significant heart failure and mild forms of AF, based on the results of the ATHENA trial—which randomized 4628 patients with non-permanent AF to either standard therapy or standard therapy plus Multaq. The ATHENA investigators didn’t exactly say that Multaq works, rather they claimed that it reduced a composite of hospitalizations and death.
This started the marketing machine in motion, the likes of which I have not ever witnessed. Read more »
*This blog post was originally published at Dr John M*
July 17th, 2011 by David Kroll, Ph.D. in Opinion, Research
Tags: 6-desmethyl-sideroxylin, 8-desmethyl-sideroxylin, Antibacterial Effects, berberine, Department of Chemistry & Biochemistry, Dr. Nadja Cech, Goldenseal, Herbal Medicine, Herbs, Hippies, Hydrastis canadensis L., Pure chemicals, Ranunculaceae, Science Based Medicine, Semi-purified extracts, sideroxylin, Staphylococcus aureus, Synergy, University of North Carolina
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So, you’re curious about herbal medicine. Is there any truth to this stuff?
Uncle Howie tells you that he read in the National Enquirer about an herb that has better antibacterial effects on cuts and scrapes than Neosporin ointment — never mind that Neosporin is composed of three different antibiotics that come originally from bacteria themselves.
So you set out on a quest to purchase some of this herb, known colloquially as goldenseal. When you go to your local Whole Hippie Dump-a-Load-of-Cash Emporium you find goldenseal alright, in about twenty different forms. On one side of the aisle are containers with loose, crushed up leaves and roots that look like medical marijuana. On a shelf, you find see-through capsules that seem to contain a powdered version of the herb. Down the aisle a bit you find boxes of blister-packs containing a proprietary extract of free-range goldenseal from the Appalachians harvested under moonlight by bare-breasted virgins. The same company also makes an ointment, allegedly procured the same way.
A scraggly young man with a rainbow-colored Whole Hippie tam comes by and says, “Dude, can I help you?” As you wave away the cloud of patchouli oil and three days of body odor, you ask him, “So, this goldenseal — which one should I buy?”
Hippie Boy looks both ways down the aisle and motions with his finger to come close.
“Dude, all this expensive stuff is just a ploy by The Man trying to make a buck with their fancy scientific words and processes. What you want is the whole herb, man — the stuff given to us by the sprites and spirits. Those capsules miss the point. Part of the magic is missing. You pay extra to get less.”
“But, dude,” you say. “I want to try the ointment, you know, for cuts and scrapes. How do I use this herb?”
The fine young man then explains how to make a poultice, an old-fashioned decoction of plant material that one wraps on a cut — sort of like collard greens.
This really seems like more trouble than it’s worth. You’re about a millisecond away from just heading down to the Done-Rite Drugs, Liquor, and Tobacco to buy a simple tube of Neosporin. But hey, it’s an experiment and you’re curious.
While you’re checking out from the health food store, a local scientist friend is in line at the next register, checking out your stash of goldenseal.
“You know, you should really go read Science-Based Medicine to get the straight dope on that stuff.”
And so, here you are. And I’m here for you.
[Note to readers: Apologies to my hippie friends. I love you all. No hippies were harmed in the drafting of this blogpost.]
Is there any scientific evidence to support a common herbalist claim that whole plant materials are “better” than semi-purified extracts or pure, individual chemicals made by the plant? Read more »
*This blog post was originally published at Science-Based Medicine*
July 17th, 2011 by Toni Brayer, M.D. in Research
Tags: Annals Of Internal Medicine, Back Pain, Group Health Research Institute of Seattle, Massage, Massage Therapist, Massage Therapy, Neck Pain, Soft tissue
2 Comments »
The Group Health Research Institute of Seattle, Washington has published a study in Annals of Internal Medicine that showed massage therapy may effectively reduce or relieve chronic back pain. I am a big believer and supporter of massage therapy and have wondered why it is not a covered benefit for treating back and neck pain. Even medical benefits savings plans offered by employers (where you put aside your own pre-tax dollars to be used for medical care) do not allow massage. Patients who get massage for musculoskeletal conditions do better and utilize less pain meds, yet is is seldom prescribed and rarely covered by any insurance plan.
This study confirmed what I have known for a long time. They looked at relaxation massage and structural massage, which focuses on correcting soft-tissue abnormalities. At 10 weeks they found Read more »
*This blog post was originally published at EverythingHealth*
July 15th, 2011 by RamonaBatesMD in Opinion, Research
Tags: Aesthetic Surgery Journal, Dermatology, Hydrocortisone, Laser, Laser Therapy, Linear Dermal Scars, Moisturizing Cream, Nonablative, Skin, Stretch Marks, striae distensae, Topical Skin Care, Treatment
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Stretch marks (striae distensae) are common. They represent linear dermal scars accompanied by epidermal atrophy. Stretch marks aren’t a significant medical problem, but can be a source of significant emotional distress.
There are many treatments available, ranging from therapy applied to the skin, laser therapy, and even more invasive surgical methods. Unfortunately, stretch marks remain a tricky problem to target, in which no established treatment exists.
A recent article in the May issue of the Aesthetic Surgery Journal (full reference below) discusses the use of fractional nonablative laser treatment for stretch marks.
Dr. Francesca de Angelis and colleagues conducted a clinical study involving 51 patients with striae, three male and 48 female, who were treated between May 2007 to May 2008. Several patients had striae on multiple areas of the body so a total of 79 striae locations were treated.
Patient ages ranged from 13 to 56 years (mean, 33 years). Fitzpatrick skin type ranged from II to IV. The duration of striae ranged from one to 40 years, with an average duration of 12 years. The striae formed as a result of pubertal growth (41%, n = 21), pregnancy (31%, n = 16), weight change (20%, n = 10), muscular atrophy (2%, n = one ), or unknown causes (6%, n = three).
Anatomical locations for treatment included the hips, breasts, abdomen, flanks, knees, buttocks, arms, thighs, and shoulders, with the majority of treatments occurring on the first three sites.
The stated objective of this study was to determine Read more »
*This blog post was originally published at Suture for a Living*
