Archive for the Medicine Category

Why are so many people on chronic medications?

Posted in Medicine, Uncategorized with tags , , , , on May 16, 2008 by Dr. CJ

A recent report revealed that over half of all Americans are on at least one medication on a chronic basis.  This analysis includes children and adults.

The article cites that medications for blood pressure and cholesterol are the most common.  Note that these problems are core features of the Metabolic Syndrome which is already at epidemic levels and steadily worsening.

Best line of the article:

"Honestly, a lot of it is related to obesity," he said. "We've 
become a couch potato culture (and) it's a lot easier to pop a 
pill" than to exercise regularly or diet. 

Another epidemic problem is the overdiagnosis of and over-prescribing of medications for so-called ADHD.  That calls for a separate post, if I dare, but no one can argue that so many children need medication to get through a school day.  That’s flat-out ridiculous and more an indicator of a parent’s ability to teach discipline and maturity than a “disorder” of the child. 

Certainly, there is also an influence from public education.  For example, I frequently see people who have either learned about their risk for certain medical conditions or about medications that are being advertised for these conditions, and this bit of awareness prompts them to initiate a discussion about it. 

There’s room for a long, complicated discussion about the necessity and ethics of pharmaceutical products being used on this scale.  As mentioned previously, I encourage patients to minimize their use of medications by addressing the important health factors

People want quick fixes, and especially easy fixes.  It still amazes me, yes, but people are far more willing to pay $30-100 / month and subject themselves to risk of liver disease, muscle injury, electrolyte depletion, and other side effects than to devote themselves to a regimen of healthy eating and regular physical activity to achieve the same results.

This report also begs the question: why are the doctors prescribing so much medication?  Aside from the obvious increase in chronic medical conditions like hypertension, hyperlipidemia, and diabetes; the philosophy of the physician is put to the test when confronted with these patients, as in drug vs. fitness.

MS Walk ’08

Posted in Exercise, Medicine with tags , , , on May 4, 2008 by Dr. CJ

I participated in the MS Walk for the first time this morning, an event to raise funds for the National Multiple Sclerosis Society in their fight against Multiple Sclerosis.

Briefly, Multiple Sclerosis is a degenerative neurologic disease with varying manifestations and varying courses. Some people live with minimal to no recurrences, whereas others suffer severe, debilitating progression leading to rapid death. There is a roughly 2:1 predilection for women, and it typically occurs between the ages of 20 and 50.

Couple reasons I did the walk: 1) I was part of a group walking in support of someone with MS, and 2) I have patients with MS and believe it’s an important area for further research (or maybe “search” is a better term).

The walk in my area was a 6.5 mile route. In talking to people at the registration area, I learned that it was 9 miles last year, 12 the year before, and once was actually 18 miles.

I couldn’t help but think this steady drop in walking distance was related to the steady decline in people’s interest in their health. I’m sure it was also a matter of getting as many people to walk (and thereby raise more money) without turning away people who are weary of physical activity. I wonder: are all charity walk distances on the decline?

You can imagine the comments along the route, too. “Is that only mile four?” “I wonder how much longer it is.” It’s too bad that 6.5 miles is an extraordinary distance for so many people. I don’t expect that everyone be in tip-top shape, but a leisurely 6.5 mile walk should be almost routine.

On average, it takes 2000 steps to walk a mile. The 6.5 mile walk would then require roughly 13,000 steps. There has been a push for the past several years to encourage people to walk 10,000 steps in a day, with pedometers even being handed out at fast-food restaurants (ah, the irony), as a general guideline to increase physical activity. If one can manage 10,000 steps in a day (which isn’t actually that hard – I’ve monitored mine in the past), today’s walk would have been only a 30% improvement in distance from a regular day.

Regardless, thanks to everyone who participated in their local MS Walk or other charity walks, for that matter. Even if you don’t manage to secure a large amount of contributions, your presence is important as a show of support.

Reduce risk of heart disease with the Polypill

Posted in Heart Disease, Medicine with tags , , , on April 2, 2008 by Dr. CJ

This paper published in the British Medical Journal ranks among my favorite, but there’s an even better sequel to it that I will review next.

The concept of a Polypill was introduced in 2003 by Wald and Law as a combination of medications and vitamins that would significantly reduce the risk of heart disease in a population.  Obviously, medications are no substitute for a healthy lifestyle, as there is inherent risk to taking any exogenous substance.  Their approach, however, was a theoretical look at combining the pharmaceutical agents and vitamins that have the best evidence for lowering cardiovascular disease risk.

They focused on the following cardiovascular risk factors:

  • Hypertension (elevated blood pressure)
  • Homocysteine
  • Platelet function

Evidence of cardiovascular disease risk reduction was based on analysis of previously published results. 

  • LDL cholesterol would be treated with a statin.
  • Hypertension would be treated with a 3-drug combination of the 5 main classes of blood pressure medications (thiazide diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers).
  • Homocysteine would be reduced with folic acid supplementation.
  • Platelet function would be addressed with aspirin.

Without going into detail about the numbers, let’s just take a look at the final analysis.  Wald and Law estimated that the cumulative risk reduction of treating all 4 of these factors by the Polypill would reduce risk of ischemic heart disease (e.g. heart attacks) by 88% and risk of stroke by 80%.

Previous studies have demonstrated that treating one risk factor has the same proportional effect (same percentage reduction) on risk irregardless of the other risk factors, so treating each risk factor does contribute an additive effect on risk reduction.

On average, they predict that this approach could result in a gain of 11-12 years of like free from heart attack or stroke for each person taking such a regimen.

Side effects from a component of this drug combination were estimated to affect 8-15% of individuals, most concerning of which would be bleeding from aspirin.

Heart disease is still the #1 cause of death in the US, and not everyone wants to take medications indefinitely to reduce their risk of heart disease.  So, who would be a candidate for this Polypill?  For individuals at relatively low risk for cardiovascular disease, there is no known significant benefit to an approach like this.  Oftentimes, the risk of side effects will outweigh benefits.  For people at high risk of heart disease, however, there may be some credence to such an approach, particularly older individuals or those with history of vascular disease.

Again, remember that this is purely a theroretical approach to reducing heart disease based on previously published studies demonstrating risk reductions of the various components of the drug combination.  In a health system that recognizes the importance of preventive medicine, this Polypill may one day become a reality.

“How can I cut get off of [or cut back on] my medications?”

Posted in Fitness, Medicine, Preventive Medicine with tags , , on February 19, 2008 by Dr. CJ

Time and time again, I hear patients request to have their medications reduced, but it is nearly always met with a blank, uninterested stare when I give them the answer.

Most of these individuals are on numerous medications for the problems associated with metabolic syndrome: high blood pressure, high cholesterol, diabetes. Since these are all major risk factors for heart disease and heart disease is the leading cause of death in the US, the medical profession takes them very seriously. Presumably, patients do, too, or they wouldn’t have sought help or agreed to take a medication in the first place.

Believe me, I don’t want to put people on any more medicine than they absolutely need – it exposes the patient to more potential problems and me to more potential liability, not to mention the time demands of discussing the ins and outs of the medication and handling refills, etc.

So . . . what’s the solution?

Pretty simple, really – FITNESS. It’s the fix-all for a multitude of conditions. All of the above-mentioned medical conditions are deeply-rooted in inactivity, obesity, etc. Our bodies require that we lead fairly active lifestyles, especially to balance the poor nutrition habits of so many. I know it’s easier to be inactive than to embark on an exercise regimen (I’ve done both).

Unfortunately, medications don’t “cure” any of these chronic conditions – they merely alter the conditions of our bodies to simulate a more normal state of being. The body needs to be re-trained on how to handle glucose (sugar), cholesterol, or blood pressure. Exercise can be free, proper diet can be cheaper than a poor diet, and the lifelong benefits outweigh the hassle of making such a lifestyle change.