Health care and Life

The health care debate is heating up, sometimes in alarming and dangerous ways. Some utterly reject that government can do anything right. Others point to an insurance industry that dumps people the moment they’re ill. And who gets left in the lurch? As ever, the consumer.

As a member-driven cooperative, NYBC lends voice to that third, often obscured voice, the consumer. Most of us working with NYBC are living with a chronic disease, some of us without any health insurance coverage, so this is not merely an academic issue.

Others have pointed to an overlooked aspect of the healthcare debate. Dr. Dean Ornish, a longtime advocate for changes in lifestyle to improve health, presents a compelling case in a recent blog in the Huffington Post. He notes that: We used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. We showed that comprehensive lifestyle changes may stop or even reverse the progression of coronary heart disease, prostate cancer, diabetes, hypertension, obesity, hypercholesterolemia, and other chronic conditions that account for at least 75% of the $2.1 trillion in health care costs.

Yes, that’s PER YEAR. That’s nearly 17% of our Gross Domestic Product. According to the Centers for Medicaid and Medicare Services, in 2006, health care spending reached a total of $2.1 trillion, or $7,026 per person, up from $6,649 per person in 2005.

Ornish’s efforts then revolved around figuring out how to get Medicaid to cover these types of approaches. And, after 14 years, they had success. This makes sense and indeed can help to measurably, and in a healthy and sustained way, help to reduce healthcare costs. While he notes that it took such a long time for the government programs to buy into this idea, it should be noted that there weren’t many private insurance companies buying into either.

While an excellent program overall, this approach does not address the many chronic, debilitating conditions that many of us face from Parkinson’s Disease and Multiple Sclerosis, to chronic infection with HIV, Hepatitis B or C, Lyme disease, let alone those suffering injury. Medical care must be comprehensive and cover everyone.

But at NYBC, clearly, we recognize the value of access to supplements as part of a comprehensive, holistic program to sustain health. So it is good to see Dr. Ornish’s perspective aired as perhaps a means to forge a more effective approach to health care, prevention and disease care. At NYBC, we feel that coverage should include not only drugs, but also dietary supplements and other legitimate holistic practitioners and practices (e.g., acupuncturists).

Indeed, the hostility manifested in policy over the decades by both the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) has resulted in some heady battles. Here, there are opportunities to expand on the current efforts of NIH to further clinical studies of CAM and dietary supplements. In addition, FDA needs to develop methods to more rapidly assess and approve claims of dietary supplements to impact health without necessarily requiring them to become “drugs.”

It’s pretty clear to us that neither the government NOR the private sector and industry can be blindly trusted. Any large organization will have flaws. The current system, though, is unbelievably cruel and must change. If there is a robust public option, it should include prevention and care that covers dietary supplements. Whatever the result, consumer groups must always be on the alert.
Next blog…Rights & Responsibilities

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New England Journal of Medicine article: Pharmaceutical companies don’t publish studies that show antidepressants less effective

The New York Times – January 17, 2008
Antidepressant Studies Unpublished
By BENEDICT CAREY
The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.
In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.

….




Pharmaceutical companies mislead the public about the effectiveness of their prescription antidepressants.

That’s the bottom line of this New York Times story, which reports on an investigation published in the New England Journal of Medicine this week.
Well, not surprising. We knew that the FDA drug approval process, which ideally should represent a gold standard in evaluating the effectiveness and safety of medicines, has been seriously compromised by its dependence on pharmaceutical company-funded research.
And, we think we know why there’s comparatively little public attention given to some very substantial research showing that such dietary supplements as DHEA, SAM-e, St. Johns Wort may be useful for depression. These are supplements, not patentable drugs, so the pharmaceutical companies can’t establish exclusive rights to them and charge enormous sums for their distribution.
If you’d like to take a look at some of the evidence about dietary supplements for depression, look under the “Depression” category of this blog, or refer to the information sheet on depression from the New York Buyers’ Club.

NAC (N-acetylcysteine) as antidote to acetaminophen toxicity

Here’s more information on NAC as an antidote to acetaminophen overdose (best-known tradename is Tylenol, but note that acetaminophen is often paired with other drugs).

emedicine work-up on “acetaminophen toxicity”, including the role of NAC as antidote:

Frequency:

• In the US: Acetaminophen is the drug most commonly ingested in overdoses and is a common co-ingestant. Acetaminophen-induced hepatic failure is the second leading cause of liver transplantation.

Mortality/Morbidity:
• Since the introduction of NAC, the mortality rate from APAP toxicity is low.
However, in its Nov. 29, 2005 edition, The New York Times reported alarm among some in the healthcare community about a rise in acetaminophen poisoning in the US. NYBC replied in a letter to the Editor:

[We were] surprised that your article “Poisonings From a Popular Pain Reliever Are on the Rise” (Nov. 29, 2005) did not mention a readily available antidote for acute acetaminophen poisoning: N-acetylcysteine (NAC), a dietary supplement that costs just a few dollars. NAC has been studied and used as an antidote to acetaminophen overdose in Europe, and more recently in the US as well. It would be too bad if your article alerted people to the dangers of overdosing on this pain reliever without mentioning the wide availability and effectiveness of the antidote.

To conclude: we fear that this may be still another case of the prevalent bias in the US healthcare community against dietary supplements, dictated frequently by pharmaceutical companies’ lack of interest in promoting low-cost, low-margin supplements (as opposed to patentable and thus highly lucrative medications). The result: while in Europe acetaminophen poisoning risk is decreased by its usual pairing with NAC in drugs, in the US this pairing is less common, with the disastrous consequences outlined in The New York Times article.

See additional NAC information on the NYBC website: NAC -Pharmaceutical Grade.

Dietary Supplements and Depression: NYBC Info Sheet

The New York Buyers’ Club has an info sheet available for those interested in finding out more about dietary supplements for depression. Here’s the introduction (printable info sheet available through the link below): 

In recent years there’s been a lot of good scientific work about using supplements to address depression.  The supplements studied have ranged from the herb St. John’s Wort, which has a long tradition of use, to molecules like SAMe, L-Tryptophan, and 5-HTP, which have drawn attention because of their role in the body’s production of serotonin, a “neurotransmitter” intimately connected with mood and cognitive function.  Other developments in depression research involve the steroid DHEA and—surprise! —fish oil.

Printable version of the info sheet, including a chart for quick comparison of these supplements as used to address depression