Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Cancer Patients In Ontario Denied Drug Coverage

I was glad to to hear from Wendy from wendysbattle.com … like my friend, she is battling stage IV colon cancer.  Unlike my friend, she lives in Ontario and has no assistance to pay for her chemotherapy.  In a jaw dropping video from a cancer press conference in Ontario, Wendy and 2 other colon cancer patients testify about being denied coverage for standard of care colon cancer therapy.  Wendy says that Ontario has valued her life at less than $18 thousand dollars.

In a recent interview with Senator Mike Kirby, I learned that one of the major problems facing the Canadian healthcare system is the cost of expensive new drugs.   The universal system was designed to have patients pay out of pocket for their medicines and have the government cover almost everything else.  When this health insurance strategy was created, drugs were very inexpensive.  However, with all of the technological advances in medicine – diseases like HIV/AIDS and cancer have become chronic, manageable illnesses with expensive treatment price tags.  And now, the lack of drug coverage is shifting unmanageable costs directly to the patient.  Sadly, Wendy is one of many victims of lack of drug coverage in Canada.

All this to say that the grass is not really greener in Canada – especially for cancer patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Cancer Isn’t Fair

Physicians see horrible things, tragic injustices caused by unexpected disease and circumstance.  We do what we can to remain compassionate – to be emotionally “present” and yet to keep the professional distance required for our survival and success.  It takes courage to set a bone, crack a chest, to do painful procedures to save lives – there must be no hesitation when minutes count.

And I suppose that our saving grace is that the majority of the patients we meet in tragic circumstances are not personally known to us.   We appreciate their humanity in a general sense, but are not pierced and incapacitated by a family tie or bond of friendship.  We are pained by their suffering – but we can cope.

That is, until we’re confronted with a loved one who is thrust into tragedy.  Two days ago, a dear friend and former coworker called me to say that she had been diagnosed with colon cancer that had metastasized to her liver.  She had just given birth to her first child at age 41.  Her only symptom?  Post-partum fatigue.

My friend is a health nut and athlete – she has lived the “gold standard” life from a preventive health perspective.  I always wanted to be more like her – eating lots of veggies and running regularly.  She has been at her target weight all her life, has the occasional glass of wine, and spends much of her free time in community service projects and charity work.  She has no history of cancer in her family – they are all hardworking, clean-living types who enjoy long, productive lives.

So when she told me about her advanced disease I almost fell off my chair.  How could this happen to her?  She is too young!  She doesn’t fit the right description… Why didn’t I catch this sooner?  Did she ever give me any hint of a warning symptom?

She told me that after having her baby she just felt really tired and was unable to bounce back as quickly as expected.  I was worried about post-partum depression, and she eventually decided to see a family physician about her fatigue.  He was unclear as to its root cause, and ordered a broad range of general blood tests – including liver function tests.  They turned out to be abnormal, and he inquired as to whether my friend might be a drinker.  She denied any such tendencies, so he scheduled an ultrasound.  The ultrasonographer noted the appearance of metastatic cancer – she had a CT scan and a colonoscopy to confirm the diagnosis of colon cancer.  We were both in shock.

And now as my dear friend faces likely surgeries and chemotherapy, I am witness to her journey – the same one that I’ve observed in strangers – but this time I have no professional defenses.  I will watch as her body is wracked by the disease’s treatments, I will understand the individual circumstances behind her bravery, I’ll know and feel everything in a personal way that I can’t control.

I am about to join the millions of cancer patients and their families on the other side of the examining room.  This time I’m not the doctor, I’m the close friend who rages against a disease that is not fair.  And I am ready to fight.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The State of Statins (Cholesterol Lowering Drugs)

We’ve known for quite a while that lowering your cholesterol can reduce your risk of heart disease, heart attack, and stroke.   Low fat diets, weight loss, and exercise can help people to control their cholesterol levels – but for those who do not succeed with these methods, a class of medications have been developed (known as “statins”) to reduce cholesterol.  These drugs have been so successful at reducing cholesterol that some doctors have joked about putting statins in the water supply.  In fact, 36 million Americans take a statin every day, generating annual sales of
$15.5 billion for the manufacturers, and making two statins – Lipitor and
Zocor – the top two best-selling drugs in the USA.

Four new studies were published in the past week about these drugs.  I thought I’d summarize the findings for you to keep you up to speed with the very latest statin information.

Statins May Reduce Mortality After Having A Stroke

Spanish researchers followed the progress of 89 stroke patients who were already taking statins.  For the first three days after the stroke, 46 patients received no statins, and 43 got their normal dose.  After three months, 27 people – 60 % of the “no statins”
group – had either died or were disabled to the point that they needed
help to live a normal life, compared with 16 people from the group
allowed to keep taking statins.
This small study suggests that stroke patients should not stop taking their statins.  More research is needed to clarify the role of statins in stroke.

Statins May Reduce The Brain Plaques Associated With Alzheimer’s Disease

Researchers at the University of Washington examined the brain tissue of 110 people who had donated their brains to research upon their death.  They found there were
significantly fewer plaques and tangles (the hallmarks of Alzheimer’s disease) in the brains of people who had taken statins compared with those who had not.  This is good news, but will require further research to determine whether or not statins could be used (or should be used) specifically for the treatment or prevention of Alzheimer’s Disease.

Statins Don’t Seem To Reduce The Risk of Colon Cancer

A group of Greek researchers conducted a review of the scientific literature to see if there may be a reduction in colon cancer rates among people who take statins.  They found no evidence that statins reduce the risk of colon cancer.

Statin Side Effects Appear To Be Ignored By Some Physicians

The journal Drug Safety surveyed 650 patients about their experience with statins.  Eighty-seven percent of patients reportedly spoke to their physician
about the possible connection between statin use and a symptom.
Physicians were  more
likely to deny than affirm the possibility of a connection. Rejection
of a possible connection was reported to occur even for symptoms with
strong literature support for a drug connection.  This report is concerning since it seems to suggest that physicians don’t take patient complaints as seriously as they should.

I asked Dr. Frank Smart what he thought about the side effects of statins and whether or not physicians should be more aware of them.

“The statin side effects exist
but in my opinion are overplayed. In my practice about 5% of people on statins
have some muscle issues. Most improve with dose reduction or change to a more
hydrophyllic compound.

Physicians should be better educated about side effects and the one who
should do the educating is pharma, and websites like Revolution Health.  Most docs are as
familiar with statin side effects as they are with other drug classes, so good
but not great. We would all love to raise the bar but it is tough as you
know.”

As many as 30% of patients reportedly experience a side effect from statins (including: headache, nausea,
vomiting, constipation, diarrhea, rash, weakness, and muscle pain) though severe muscle damage is very rare (for example, one article reported 24 cases in 252,460 patients.)  Overall, statins have many health benefits and are well tolerated by the majority of patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Having Poor Taste Can Lead To Weight Loss

I had an interesting dialog with Dr. Bruce Campbell recently.  In his blog he described a patient  who lost about 60 pounds after losing his sense of taste.  The patient had undergone radiation therapy for throat cancer, and in the process lost his ability to taste food.  He soon lost interest in eating, and eventually dropped 60 pounds – not from the cancer, but from the side effect of radiation therapy.  In this case there was a happy ending (his sense of taste eventually returned and he regained some of his weight) but it made me think about the relationship of flavor to obesity.

Just as I was musing on this very fact, a new research study was published in the journal Neurology.  It suggested that unexplained weight loss was an early warning sign of dementia.  They speculate that this could be linked to another early sign of dementia: loss of the sense of smell.  Of course taste is largely a function of smell, so we can easily understand how people lose interest in eating when they can’t enjoy the flavor of food.

Wouldn’t it be interesting if we could temporarily alter a person’s sense of taste in order to affect weight loss?  I doubt I’m the first to think of this… has anyone else heard of such a strategy?  Surely this would be a little bit less invasive and dangerous than bariatric surgery.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Low Cholesterol And Cancer Risk

A provocative press release crossed my desk today, “Study Finds Association Between Low Cholesterol Levels and Cancer” with subtitle: “Benefits of Statin Therapy Outweigh Small Risk.”  Well that’s fairly terrifying, isn’t it?  It sounds as if they’re saying that taking a statin (like lipitor or zocor) is good for your heart but might carry with it the “small” risk of developing cancer.

First of all, let me assure you that this is a gross misinterpretation of the metanalysis.  The authors themselves never postulated a cause and effect between statins and cancer, and in fact did all they could to avoid drawing this conclusion.  They merely observed that there was a slight trend towards higher cancer rates among people with low LDL cholesterol.

There are two very good explanations for the higher cancer rates in people with low cholesterol:

1. Everyone knows that “unexplained weight loss” is an ominous sign.  Often times a patient’s first clue that they have cancer is sudden weight loss – since cancer has a voracious appetite and steals nutrients from the rest of the body.  When people lose weight, their cholesterols decrease.  So it’s possible that low LDL cholesterol is really just a surrogate marker for those who already have very early stages of cancer that have not yet been detected otherwise.

2.  Statins are well known to reduce cholesterol and the atherosclerotic plaques that put people at risk for heart attacks and strokes.  Lower cholesterol levels can reduce overall mortality risk/year by 30%, and so people live longer when they have lower cholesterol levels.  People who live longer extend their opportunity to develop cancer.  And so lower cholesterol levels inadvertently raise your cancer risk simply because they may extend your life.

Why else do I think the link between cancer and statins is faulty?  Because the observed increase in cancer rates was in ALL cancer types – the genetics of cancer is so complex, and the reasons why certain cell types begin to divide in an uncontrolled manner is so diverse, that it’s hard to imagine any possible trigger could stimulate all cells to become cancerous.  Also, most cancers develop very slowly, and the 5 year window in which the authors observed people taking statins and developing cancers is too short to be a cause and effect.  And finally, previous statin safety studies showed no link between them and the development of any form of cancer.

The Journal of the American College of Cardiology admits in an
accompanying editorial, “In the 5 years that we have been stewards of
the Journal, no other manuscript has stimulated such intense scrutiny
or discussion.”  Do I think they should have published this study?  Yes – but to me the most interesting question out of all of this is: could cholesterol screening be used for early cancer detection?  If an extra low LDL is observed, maybe that should prompt some additional investigations to rule out occult malignancies?

Obviously, more studies are needed to determine the potential validity of such an approach… but for now, there is absolutely no reason (based on this study) to cease statin therapy for fear of developing cancer.  Hope that allays some fears!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »