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Good News and New Medicines Vol. 8 Number 1
Welcome to another edition of GNNM edition—full of information to talk to your doctor about. There are many gaps in healthcare-both in information and treatments for patients and their families. If you or a loved one has suffered a heart attack, you'll be glad to learn about a national group called The Mended Hearts (www.mendedhearts.org). Since 1950, they've actually been sending volunteers right to the hospital-volunteers who have heart disease themselves and can share their experience and insight. They also have a great new tool---a book called Medicines and Your Family, National Treatment Guidelines! Find a local chapter by calling 1-888-432-7899. In past editions, it's important to focus on steps we can ALL take to live longer—including PREVENTION of problems where we can.
Can the Swiss work their magic for you? Tablets and capsules have to fall apart before they get into your body (are absorbed). Many of us have problems even swallowing pills and might skip vitamins or minerals even though they can do a lot of good. What if you could find products that you could put in water, they'd bubble and would make a vitamin drink that tastes great and gets right into your body? Enter Peak Nutritional and LiFizz. They've brought Swiss technology to the US--just drop these multivitamins and calcium into as little as 4 ounces of water and you'll be able to put the same vitamins that I take to work for you! Visit www.lifizz.com to find out how good a vitamin can taste! Have you ever talked to your doctor about your individual risk factors based on your lifestyle, family history and existing medical conditions? Please do this the next time you go to the doctor. I firmly believe that my father would be alive today if he had stopped smoking, lost some weight, took control of what was probably pre-diabetes and got access to important tests earlier. Well designed risk assessment (checking problems that YOU may be headed for) can save your life! Let's take a look at this. In many cases-YES. Can you blame your parents? Well, you might be able to, but the smarter idea is to find out what conditions or diseases troubled them (and their brothers and sisters), because they could have an impact on how likely YOU will be to develop a problem. A good example is heart disease. If there is diabetes in your family and high blood pressure and increased cholesterol, and most definitely, if YOU have those same problems—you are at high risk for heart disease. The smart thing to do is to talk to your doctor about important risk factors that you can change. Set a deadline for this. Promise your loved ones that you will do it this week. Here is something you can do NOW. Visit www.americanheart.org. Click on the
profiler section.
What will this do? If you fill out the information honestly—such as the information on cholesterol, it will calculate your individual ten-year risk for coronary heart disease. It tells the truth! In other words, it will make you powerful with objective information and help you understand your individual risk. This is actually part of the American Heart Association national site. Once you've learned about your risk, print out the information and take it to your doctor. This is a great way to start an honest talk about risk, and what you can do to lower the risk that you or a loved one may face.
Please remember, IF your doctor thinks you need a prescription—learn about your medicine from an objective source. While my bias is clear, please learn more about your medicines. The best colleague any doctor can have is a fully informed patient. The current Essential Guide to Prescription Drugs will help you become a more powerful patient! You can order it on this site, or if you prefer to order directly from my office--print the order form and fax it to Medicine info at 410-820-5867. It is available at any bookstore, through the Doubleday Book club or Costco.
It certainly may have been—they've been keeping me busy Some of my new friends include: AARP and Prime Time Radio—best regards to Janelle and Mike, WBZ in Boston and Jordan Rich, Reggie Bryant on WHAT in Philadelphia is In Pursuit of Truth and is someone to listen to, Warren Krech on Daybreak KLIK makes the time sail by, Kristine Phillips on Secure Retirement Radio brings insight to a new level. WAMU had some great questions and extremely interesting callers. Visit WAMU at www.wamu.org. You can listen to past programs of The Kojo Nnamdi Show right on line (best to catch it live as well on your local NPR station)!
This may well have been the case. Visit CN8 and Comcast. Real Life and Mary Amoroso is television worth watching.
It is always better to prevent a disease or condition than to have to treat it. I have said this time after time. The talented team at the National Institutes of Health and the National Heart Lung and Blood Institute (NHLBI) have published the latest expert recommendations on blood pressure. JNC VII. This stands for Joint National Committee, version 7. Much like diabetes and prediabetes, you are now going to hear something called prehypertension. Why? Because in my opinion, and in theirs, it's good medicine. What used to be called "normal" blood pressure can actually be thought of as the beginning of undesirable blood pressure. Most importantly, because damage is being done to your organs and blood vessels and because risk of heart attack and stroke actually increases--it's just plain smart to start weight loss, risk checks and in some cases, medicines (such as a water pill or diuretic) earlier.
"Updated Cholesterol goals and guidelines?" Yes, new ones for each. I know you've read this before, but heart disease has such a pervasive impact I'm mentioning it again. Find out if any cholesterol checks or diabetes screenings are coming up in your town. Get it done. When you find out about a health fair or cholesterol screening—email ten of your friends and tell them that YOU are going to take control by getting your numbers checked. Bring THEM along too! Remember, you can check your coronary heart disease in just a few minutes by visiting www.nhlbi.nih.gov/guidelines/cholesterol/pat_pub.htm. The numbers that you get from a lipid panel (more than just a simple total cholesterol) can help give you a look at how well your medicines are working. If you get a 9-12 hour fasting test, it's important to take these results (or ask the person doing the test) to have the numbers sent to your doctor or clinic! Next will probably come some lifestyle changes or needed medicines.
Absolutely! I realize that cost is a critical barrier for many many people. A Kaiser Family Foundation survey found that in 1999, more than 13 million seniors did not have coverage for prescription medicines. Like others, I'm hoping that a significant Medicare Prescription Drug Benefit will be written and will become a reality. Why do I think this is important? A recent study by the Society for Women's Health Research (reported On October 2, 2002) found that heart disease could cost more than $400,000 over the lifetime of a woman. Because Medicare will often ultimately be paying for a significant portion of such care, why on earth would they not push hard for a prescription drug benefit? Given this new information about the huge cost of heart disease, it also seems prudent to FUND programs for PREVENTION of heart disease as well as treatment. The cost of medicines is a real barrier to effective care in the U.S. A. The technical term for this is COST AVOIDANCE. Think of the expense that Medicare could save if even the degree of heart disease could be lessened and hospitalizations and surgery avoided. In the meantime, help for you and your family or loved ones now can be found by using your brain and visiting:
1) Visiting www.rxassist.org and www.needymeds.com. These sites offer balanced and objective information that can help a lot with details about drug plans, contact information and state programs. 2) One of the first places to start to save is right in your doctor's office when you first have a talk about a new medicine. Ask if there is a generic. For example, one of the divisions of Blue Cross and Blue Shield (www.bcbsm.com) did a price comparison in 2000 for their most prescribed medicines. Some of the savings (where generics were available) topped 50%! 3) Your state may be one of the 34 states that have some kind of program to give coverage for medicines. Visit www.ncsl.org/programs/health/drugaid.htm for the National Conference of State Legislatures and learn more. 4) Many of the pharmaceutical companies offer a limited supply of medicine. Call 1-800-762-4636 or go to www.pharma.org to get more information. 5) The Together RX Card is the broadest card that I'm aware of. Call 1-800-865-7211 to get details on this drug discount card for the elderly and disabled. From Abbott, Astra Zeneca, Aventis, Bristol Meyers-Squibb, GlaxoSmithKline, Janssen, Novartis, Ortho-McNeil and Novartis. Together RX covers more than 150 medicines, can be found at www.togetherrx.com 6) Don't forget about the VA or Veteran's Administration if a member of your family or if you are a vet. Visit www.va.gov or call 1-877-222-8387. 7) While there are others, the final resource I want to give you is the Agency on Aging for your local area. Visit www.eldercare.gov or call 1-800-677-1116 to learn more about community based medicine assistance programs!
It is widely accepted, but often disregarded that as we age, our cholesterol increases. Your doctor may mention more about Framingham (a huge study that is now the starting point for looking at risk of heart disease)—yet some experts say that this only being able to predict some 80% of problems. I think of this as the Framingham Gap. What does this mean? As usual, it means that there are more factors involved in heart disease than Framingham accounts for. It's fascinating to realize that there are actually at least 7 kinds of bad cholesterol (LDL) and at least five kinds of good cholesterol (HDL). While it is a little clinical, you should also know that there are patterns of good and bad cholesterol that are desirable. You can find out more by visiting www.Bhlinc.com.This is the Berkeley Heart lab web site.
Well, more correctly, an electron beam computed tomography (also known as EBCT or EBT). This amazing technology can actually give a "virtual tour" of the coronary arteries. Once your doctor orders an EBCT, you go to an EBCT center, and what happens is an ultrafast CAT scan, which is timed (gated) to the heart rate. While you may think of this as a lengthy procedure, amazingly, the test only takes five minutes. EBCT may be one of the leading edge tests that will help bridge the Framingham Gap and identify people who may not even have any symptoms, yet actually do have heart disease. The test leads to a result called a calcium score. You can find out more at www.heartsavers.md. "Any update on the CURE trial you mentioned?" You'll remember that CURE--Clopidogrel (the brand is Plavix) in Unstable angina to prevent Recurrent Events. This was a study presented at The American College of Cardiology meeting. I view it as a true breakthrough (see the current Essential Guide to Prescription Drugs). It is rare to have information presented that actually can help PREVENT problems. The lead investigator (Dr. Salim Yusuf) noted that widespread use of clopidogrel and aspirin in people with Acute Coronary Syndromes (ACS) such as unstable angina or non-Q-wave MI could prevent 50,000-100,000 heart attacks, strokes or deaths EVERY year in North America Find The American College of Cardiology at http://www.acc.org/. The result of this study was that the FDA labeling for clopidogrel was augmented to include use of clopidogrel for preventing heart and blood vessel problems (cardiac events such as heart attack, cardiovascular death or stroke) in people with acute coronary syndrome (unstable angina or non-Q-wave heart attacks) in combination with aspirin (75-325 mg a day). Amazingly, the update is that despite such great research, medicines such as Plavix, beta blocker medicines and ACE inhibitors may still be under used. In some cases, people who are great candidates for the benefits of these medicines (such as some women), never get a prescription. Talk to your doctor about current guidelines and the best medicines to help prevent a first or second heart attack or stroke. Helpful References:
Yes, progress in the fight against cholesterol continues! The generic name is rosuvastatin (brand Crestor) has been approved by the FDA. It is a third generation "statin" type medicine which blocks your body from making cholesterol similar to other statins (HMG-CO-A reductase inhibitors). The interesting aspect of rosuvastatin will be its potency and ability to increase good cholesterol (HDL). OF the available medicines, how well your kidneys work needs to be checked, but I think rosuvastatin will be an interesting addition to current treatments. More coverage may be given to a product which comes from sugar cane and is known as policosanol. It's actually a mixture of at least eight different substances, and lowers undesirable (LDL) while increasing the good (HDL) cholesterol. This may be worth talking to your doctor about. Of course, treatment, treatment goals and ongoing use of any prescription or natural medicine should be determined by your doctor and current research. IBATS: Yes, ibats, well...more completely—ileal bile acid transport inhibitors. While I realize that this is a mouthful, an IBAT lowers LDL by tricking the liver into using cholesterol to make bile acids. The bile acids are then removed by the intestines.
Yes. you may recall seeing something about this in previous editions and progress by a company called Generex Biotechnology (www.generex.com). While this is early data, it appears to be applying the same technology that the company is using to make spray INSULIN to try to make a spray MORPHINE. I deal a lot with pain management and can clearly see the benefit of a potent pain relief spray that uses morphine as the medicine!
Info on rosuvastatin is at www.astrazeneca.com and www.fda.org. Find out more about policosanol in the American Heart Journal (2002;143:356-365). The American Pain Society can be reached at: http://www.ampainsoc.org/. You can find Generex Biotechnology at www.generex.com.
You may be able to. The thing we call diabetes often starts in a subtle way. Finally, under the Bush administration, we have a Health and Human Services Director (Tommy Thompson) who is able to focus attention and then organize that attention into a rational campaign. Let's get some answers to the problem itself first. About 17 million Americans have Diabetes. Roughly 5 million diabetics don't know they have it. Of critical NEW importance is the fact that 16 million Americans have pre-diabetes. This used to be called impaired glucose tolerance or impaired fasting glucose—terms that should be restricted to medical students. Pre-diabetes is a much better way to describe the situation, along with thinking of diabetes itself as a continuum. The first thing to realize is that while your car usually runs on gas, your body usually runs on sugar (what your doctor calls glucose). An organ called a pancreas makes insulin. Insulin works to get the sugar into your cells so that it can be used as fuel. This is a great system if everything works. In pre-diabetes, your body starts to lose the ability to deal with sugar. This used to be called adult onset diabetes, but is being seen in youngsters because we have a national weight problem—something that CLEARLY increases diabetes. The sad reality of pre-diabetes is that people who have it also have a 50% increased risk of heart attack or stroke. Who should be checked for pre-diabetes? 1: People over 45, 2:overweight young people who: have high blood pressure, or high triglycerides or low levels of the good cholesterol known as HDL, people with a family history of diabetes, those who had diabetes during pregnancy or had a baby that weighed more than 9 pounds, and those who belong to one of the minority groups thought to be at risk: Asians, blacks, Hispanics, native Americans and Pacific Islanders. The great news is that weight loss and regular exercise (as done in DPP below) can make pre-diabetes a battle you can win.
Of course! The results of DPP (Diabetes Prevention Program) were reported in the February 7, 2002 edition of the NEJM (New England Journal of Medicine). There are now two effective ways to help avoid diabetes. The first one is to change your lifestyle. This can lead to a 58% decrease in new type 2 diabetes! The second way to fend off diabetes is with metformin (Glucophage). People in the study who took that medicine had a 31% lower incidence of diabetes. Why is this study important? Half of us are overweight. When you look carefully at the lifestyle changes--they are actually things that most of us can do. For example--if you can lower your weight by only 7 % and go for a half an hour walk five times a week--you can actually be on the way to PREVENTING diabetes. If your doctor decides that a prescription medicine in required--metformin now has great data to say that it makes a clear prevention difference! See the current Essential Guide for info on metformin. The American Heart Association released a scientific statement on obesity, Insulin Resistance, Diabetes, and Cardiovascular Risk in Children (Circulation. 2003;107:1448). This is the first set of guidelines to my knowledge that will help prevent (primary prevention) of heart disease in children.
Search the web at: www.americanheart.org,http://www.theheart.org/, http://www.diabetes.org/ Welcome to Late Breakers The intent of this section is to present both evolving information from good science and studies or reputable panels that does not as yet have a clear conclusion. I'll give a reference, the medicine(s) involved and where to find more information so you and your doctor can reach your own conclusions.
1)C Reactive Protein or (CRP) 2)Aspirin resistance Large studies are often the most significant clinical trials. A previous review of more than 20,000 blood samples lead to the emergence of C Reactive Protein as a measure of heart and blood vessel (cardiovascular) risk. Importantly, CRP appears to actually identify risk that may not be shown with bad cholesterol checks (LDL) alone. Dr. Ridker has accomplished much of the research on CRP. The American Heart Association also has a set of guidelines on who should be tested. Take a look at The New England Journal of Medicine from November 14, 2002 (Ridker, PM, Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events.N Engl Jrnl Med 2002;347:1557-1565).
From the time when early research was made on white willow bark--to the time when salicylates were discovered--the development of aspirin is an amazing step forward in medicine. It has been so for more than 100 years and still more is being learned. Once it was known that aspirin could reduce fever and help control pain, it became widely used. Because aspirin has an effect on clotting, it began to be used to help prevent strokes and heart attacks. Subsequent data emerged that showed an even broader application in cardiology. Aspirin itself has data to show that it helps prevent first heart attacks, second heart attacks and even was shown to be of benefit in otherwise healthy people who had risk factors for heart attack. In the event that a heart attack did happen, aspirin (325 mg immediate release) was found to help limit the damage of the heart attack. The data that is evolving extends to combination use (see CURE data above as an example of a great benefit), but also in dosing after a heart attack. A new term has emerged known as—"aspirin resistance." The background data came from a review of patients who were previously studied in the Heart Outcomes Prevention Evaluation (HOPE trial). John Eikelboom and his associates tested the urine of 488 HOPE patients who took low-dose aspirin, but had a heart attack despite that therapy. The researchers compared urine levels of a substance called 11-dehydro thromboxane B-2. While the name is complicated, testing for it simply is a measure of how much of a particular clotting factor (thromboxane A2) each person made. You may also want to think of it as a measure of how much thromboxane A2 the aspirin has to fight in order to have its beneficial effect on blood clotting elements called platelets. What the researchers learned was that the higher the urine level of thromboxane B2, the greater the chance for a heart attack (MI) or for cardiovascular death. This study may have identified a urine test that can help identify patients who may be at risk for continued heart attacks—despite low-dose treatment (Eikelboom JW, et al. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation 2002.) This article can be accessed from www.americanheart.org and their publications section. The researchers conclude that high urine levels of thromboxane B2 can be used to find people who would be resistant to usual doses of aspirin. In my opinion, it would be extremely interesting to see the effect of increasing the aspirin dose in an "aspirin resistant" population to try to figure out how best to address this new issue.
Aspirin resources:www.aspirin.org, www.ahcpr.gov, www.ashsnet.org and www.bayeraspirin.com
Absolutely—the latest
bullet fighting HIV is called FUZEON. This medicine helps keep HIV out of
cells--the FIRST in a class of fusion inhibitors. I believe that the combined
skill of Roche and Trimeris (the developer) will overcome any manufacturing
difficulties and we will eventually see Fuzeon as part of the backbone of HIV
treatment.
"What is this about how dietary supplements Hopefully, this will stop. A notice on the FDA web site shows that once again Tommy Thompson is doing his job as Secretary of Health and Human Services. To learn more about Thompson's stance on creation of Good Manufacturing Practices (GMPs) for dietary supplements and other issues, visit the FDA news link below. Thompson will also apparently be moving to strengthen mandatory ephedra warning labels to protect the public from potential danger of ephedra and other products. The FDA has already sent warning letters to one company advertising their ephedra product as an herbal XTC. A review of ephedra was published by the Rand Corporation.
Search the Web at: http://www.nimh.gov/ and www.nimh.gov/anxiety Visit FDA news at www.fda.gov/bbs/topics/NEWS/2002/NEW00833.html). Visit the American Heart Association at http://www.americanheart.org/ for blood pressure information and other info on keeping our hearts healthy. The National Institute of Mental Health to view http://www.nimh.gov/ and a great document that outlines info on depression, anxiety, post-traumatic stress, generalized anxiety disorder and others.
This term typically relates to an accelerated approval program of the FDA. What this usually means is that a medicine will be available much more rapidly than usual. A recent example is ZD 1839 (Iressa). Iressa is used to treat advanced non-small cell lung cancer (NSCLC). The drug is the first of a class of medicines known as selective epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TK). You may see this referred to as a tyrosine kinase blocker. In any case, the rapid approval process is reserved for situations where life-threatening diseases are involved and when the new medicine appears to offer benefits over existing treatments. Iressa was approved. Visit www.fda.gov and www.astrazeneca.com for approval data.
Help and hope for a loved one after a heart attack: The latest HIV/AIDS research: Alzheimer's Disease Guidelines: http://www.alzla.org/. Just click the button titled Treatment Guidelines. Balanced and objective info on heart disease: Balanced and objective medical research: http://www.clinicaltrials.gov/ For information on Cancer: Balanced and objective cholesterol information: http://www.nhlbi.nih.gov/. For information on Diabetes: http://www.diabetes.org (ruboxistaurin (a protein kinase Cb inhibitor) is interesting) www.americanheart.org (see The Heart of Diabetes) For information on Leukemia: Information from the National Heart, Lung and Blood Institute: For information on pain: www.canadianpainsociety.ca Information on how many prescriptions are written each year: Information on vaccines: www.cdc.gov/nip/recs/child-schedule.htm Timely news and guest appearances by Dr. Rybacki: www.wamu.org
Stay well, Dr. Jim Rybacki |
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What is effervescence and how can it help vitamins and minerals? 
Does it start with your genes? 
"Was that you I heard on the radio?"
"Was that you I saw on TV?" 
"What
is this about New Guidelines for high blood pressure (hypertension)?"
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References:
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suggestions on how to save money?" 
Balanced and objective
web sites such as:
What about aging and
risk?
Did
you know that you could get an X-Ray of the heart?
"Any
new options in fighting cholesterol?"
"Could
there be a spray morphine?" 
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References:
"Can
I prevent diabetes?"
"Show me some studies!"
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There
are two topic areas for this section:
"What
on earth is aspirin resistance?"
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"Anything new to treat
HIV?"
The general site is 
"What
about counterfeit medicines?" Unfortunately, even in healthcare, unscrupulous people
exist. The FDA has a new program to try to combat the problem. If you visit 
Helpful
References:
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does fast tracked mean?"
Search
the web further on one of these balanced and objective web sites!
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