Friday 9 December 2011

Seven Diseases Big Pharma Hopes You Get in 2012

Supply-driven marketing not only turns the nation into pill-popping hypochondriacs, it distracts from Pharma's drought of real drugs for real medical problems.

It used to be joked that a consultant is someone who borrows your watch to tell you what time it is. These days, the opportunist is Big Pharma, which raises your insurance premiums and taxes while providing you "low-priced" drugs that you paid for.
How did Pharma get a good third of the United States taking antidepressants, statins, and Purple Pills, albeit at low prices? By selling the diseases of depression, high cholesterol, and gastroesophageal reflux disease, or GERD. Supply-driven marketing, also known as "Have Drug — Need Disease and Patients," not only turns the nation into pill-popping hypochondriacs, it distracts from Pharma's drought of real drugs for real medical problems.
Of course, not all diseases are Wall Street pleasers. To be a true blockbuster disease, a condition must (1) really exist but have huge diagnostic "wiggle room" and no clear-cut test, (2) be potentially serious with "silent symptoms" said to "only get worse" if untreated, (3) be "underrecognized," "underreported" with "barriers" to treatment, (4) explain hitherto vague health problems a patient has had, (5) have a catchy name — ED, ADHD, RLS, Low T or IBS — and instant medical identity, and (6) need an expensive new drug that has no generic equivalent.
Here are some potential blockbuster diseases Pharma hopes you get in 2012.
Adult ADHD
Everyday problems labeled as "depression" sailed Pharma through the last two decades. You weren't sad, mad, scared, confused, remorseful, grieving, or even exploited. You were depressed, and there was a pill for that. But depression peaked just like the Atkins Diet and the Macarena. Luckily, there is adult ADHD (Attention Deficit Hyperactivity Disorder), which has doubled in women 45 to 65 and tripled in men and women 20 to 44, according to the Wall Street Journal.
Like depression, adult ADHD is a catch-all category. "Is It ADHD or Menopause?" asks an article in Additude, a magazine devoted exclusively to ADHD. "ADD and Alzheimer's: Are These Diseases Related?" asks another article in the same magazine.
"I'm Depressed. Could it be ADHD?" says an ad in Psychiatric News, showing a pretty but pouting young woman. In the same publication, another ad titled "Broken Promises" says, "Adults with ADHD were nearly 2x more likely to have been divorced," while exhorting doctors to "screen for ADHD."
Adults with ADHD are often "less responsible, reliable, resourceful, goal-oriented, and self-confident, and they find it difficult to define, set, and pursue meaningful internal goals," says an article cowritten by Harvard child psychiatrist Dr. Joseph Biederman, who is credited with putting "pediatric bipolar disorder" on the map. They "show tendencies to being self-absorbed, intolerant, critical, unhelpful, and opportunistic," and "tend to be inconsiderate of other people's rights or feelings," says the article, describing most people's brothers-in-law.
Adults with ADHD will have trouble keeping a job and get worse without treatment, says WebMD, tapping into the second requirement of a blockbuster disease — symptoms worsen without pills. "Adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks, or completing work within time limits," according to the website, whose original partner was Eli Lilly.
How did Pharma get five million kids and now, maybe, their parents on ADHD meds? Ads on 26- by 20-foot screens in Times Square that ask "Can't focus? Can't sit still? Could you or your child have ADHD?" four times an hour couldn't hurt. (Bet no one had trouble focusing on that!)
Still, convincing adults they aren't sleep deficient or bored but have ADHD is only half the battle. Pharma also has to convince kids who grew up diagnosed as ADHD not to quit their meds, says Mike Cola of Shire (which makes the ADHD drugs Intuniv, Adderall XR, Vyvanse, and the Daytrana patch). "We know that we lose a significant number of patients in the late teen years, early 20s, as they kind of fall out of the system based on the fact that they no longer go to a pediatrician."
A Shire ad in Northwestern University's student paper this year takes the issue head on. "I remember being the kid with ADHD. Truth is, I still have it," says the headline splashed across a photo of Adam Levine, the lead singer of Maroon 5. "It's Your ADHD. Own It," was the tagline. (Was "Stay Sick" the runner-up?)
Of course, pushing speed on college kids (or anyone, for that matter) isn't too hard. Why else do meth dealers say, "First taste free"? But Pharma is so eager to retain its pediatric ADHD market, it has funded for-credit courses for doctors, such as "Identifying, Diagnosing, and Managing ADHD in College Students" and "ADHD in College: Seeking and Receiving Care During the Transition From Child to Adult."
To make sure no one thinks ADHD is a made-up disease, WebMD shows color-enhanced Pet scans of the brains of a normal person and an ADHD sufferer (flanked by an ad for Vyvanse). But it is doubtful the scans are really different, says psychiatrist Dr. Phillip Sinaikin, author of Psychiatryland. And even if they are, it proves nothing.
"The crux of the matter is that there is simply no definitive understanding of how neuronal activity is related to subjective consciousness, the age-old unsolved body/mind relationship," Sinaikin told AlterNet. "We have not advanced beyond phrenology, and this article in WebMD is simply the worst kind of manipulation by the drug industry to sell their overpriced products, in this case a desperate effort by Shire to maintain a market share when Adderall goes generic."
Rheumatoid Arthritis
Rheumatoid arthritis is a serious and dangerous disease. But so are Pharma's immune-suppressing biologic drugs like Remicade, Enbrel, and Humira, which are pushed to treat it. While RA attacks the body's own tissues, leading to inflammation of the joints, surrounding tissues, and organs, immune suppressors can invite cancers, lethal infections, and activate TB.
In 2008, the FDA announced that 45 people on Humira, Enbrel, Remicade, and Cimzia died from fungal diseases, and investigated Humira's links to lymphoma, leukemia, and melanoma in children. This year, the FDA warned that the drugs can cause "a rare cancer of white blood cells" in young people, and the Journal of the American Medical Association (JAMA) warned of "potentially fatal Legionella and Listeria infections."
Immune-suppressing drugs are also dangerous to the pocketbook. One injection of Remicade costs up to $2,500; a month's supply of Enbrel costs $1,500; and a year's supply of Humira costs up to $20,000.
Once upon a time, RA was diagnosed from the presence of "rheumatoid factor" and inflammation. But, thanks to Pharma's supply-driven marketing, stiffness and pain are all that are required for the diagnosis today. (Athletes and people born before 1970 — line forms to the left!)
In addition to diagnostic wiggle room and a catchy name, RA has other blockbuster disease requirements. It  will "only get worse" if untreated, says WebMD, and it is often "misdiagnosed" and underreported, says Abbott's Heather Mason, because "people often don't know what they have for a while."
So serious a disease, it costs over $20,000 a year to treat but so subtle you may not know you have it? RA sounds like a blockbuster.
Fibromyalgia
Another underreported disease is fibromyalgia, characterized by widespread. unexplained bodily pain. Fibromyalgia is "almost a textbook definition of an unmet medical need," says Ian Read of Pfizer, which makes the first drug to be approved for fibromyalgia, the seizure pill Lyrica. Pfizer gave nonprofit groups $2.1 million in 2008 to "educate" doctors about fibromyalgia and financed PSAs (pharma service announcements) depicting sufferers describing their symptoms without mentioning a drug. Lyrica now makes $3 billion a year.
Still, Lyrica has to fight Cymbalta, the first antidepressant to be approved for fibromyalgia. Eli Lilly prepositioned Cymbalta for the physical "pain" of depression in a campaign called "Depression Hurts" before the fibromyalgia approval. Treatment of a fibromyalgia patients with either Lyrica or Cymbalta hovers around $10,000, say medical journals.
Pharma and Wall Street may be happy with fibromyalgia drugs, but patients aren't. On askapatient.com, the drug-rating website, patients on Cymbalta reported chills, jaw problems, electrical "pings" in their brain, and eye problems. This year, four patients reported the urge to kill themselves, a frequently reported side effect of Cymbalta. Lyrica users on askapatient reported memory loss, confusion, extreme weight gain, hair loss, impaired driving, disorientation, twitching, and worse. Some patients take both drugs.
SLEEP DISORDERS
Middle of the Night Insomnia
Sleep disorders are a goldmine for Pharma because everyone sleeps — or watches TV when they can't. To churn the insomnia market, Pharma rolls out subcategories of insomnia, such as chronic, acute, transient, initial, delayed-onset, terminal, early-morning, menopausal, and the master category of nonrestful sleep. This fall, Pharma rolled out a new version of Ambien for "middle-of-the-night" insomnia called Intermezzo, even though Ambien is paradoxically notorious for middle-of-the-night awakenings: people "waking up" in an Ambien blackout and walking, talking, driving, making phone calls, and eating food.
Many became aware of Ambien's "lights-on-nobody-home" effect when former Rhode Island Representative Patrick Kennedy drove to Capitol Hill to "vote" at 2:45 a.m. in 2006 on Ambien and crashed his Mustang. But it was Ambien's EWI effect — eating while intoxicated — not DWIs that gave the pill its worst rap. Fit and sexy people awoke amid mountains of pizza, Krispy Kreme, and Häagen-Dazs cartons, their contents consumed by their evil twin on Ambien.
Excessive Sleepiness and Shift Work Sleep Disorder
Needless to say, people with insomnia won't be bright-eyed and bushy-tailed the following day —  whether they didn't sleep or whether they have sleeping pill residues in their system. In fact, they are actually suffering from the underrecognized and underreported epidemic of Excessive Daytime Sleepiness. The main medical causes of EDS or ES are sleep apnea and narcolepsy, but last year Pharma rolled out a lifestyle-caused "Shift Work Sleep Disorder." (No, it doesn't meant you can't sleep because your partner "shifts" in his or her sleep.) Ads for Provigil, a Schedule IV stimulant that treats EDS along with Nuvigil show a judge in his black robe, nodding out on the job, with the headline "Struggling to Fight the Fog?" ("Yo! Your Honor! I'm trying to plead!").
Of course wakefulness agents contribute to insomnia, which contributes to wakefulness problems in a kind of perpetual pharmaceutical jet lag. In fact, the sleeping pill/alertness aid habit is so common, it threatens to create a new meaning for "AA" — Adderall and Ambien!
Insomnia That Is Really Depression
Sleep disorders have also given a new lease on life to antidepressants. Doctors now prescribe more antidepressants for insomnia than they do sleeping pills, according to CNN. They also often combine them, since "insomnia and depression often occur together, but which is the cause and which is the symptom is often unclear."
WebMD agrees with doubling the drugs. "Depressed patients with insomnia who were treated with both an antidepressant and a sleep medication fared better than those treated only with antidepressants," it writes. Ka-ching!
In fact, many of the new blockbuster diseases from adult ADHD and RA to fibromyalgia are treated with new drugs piled on top of existing ones that aren't working, a Pharma contrivance called polypharmacy. It brings to mind the store owner who says, "I know that 50 percent of my advertising is wasted — I just don't know which 50 percent."
Martha Rosenberg frequently writes about the impact of the pharmaceutical, food, and gun industries on public health. Her work has appeared in the Boston Globe, San Francisco Chronicle, Chicago Tribune, and other outlets.

Read the original artcile here

New Study Supports Claim That Breast Screening May Be Causing More Harm Than Good

Research: Possible net harms of breast cancer screening: Updated modelling of Forrest report

A new study published on bmj.com today supports the claim that the introduction of breast cancer screening in the UK may have caused more harm than good.

Harms included false positives (abnormal results that turn out to be normal) and overtreatment (treatment of harmless cancers that would never have caused symptoms or death during a patient's lifetime). This may be because the cancer grows so slowly that the patient dies of other causes before it produces symptoms, or the cancer remains dormant or regresses.

It shows that the harms of screening largely offset the benefits up to 10 years, after which the benefits accumulate, but by much less than predicted when screening was first started.

The Forrest report in 1986, which led to the introduction of breast cancer screening in the UK, estimated the number of screened and unscreened women surviving each year over a 15-year period. Costs and benefits were measured in quality adjusted life years or QALYs (a combined measure of quantity and quality of life) but it omitted harms.

It suggested that screening would reduce the death rate from breast cancer by almost one third with few harms and at low cost.

Since the Forrest report, the harms of breast cancer screening have been acknowledged. So, researchers at the University of Southampton set out to update the report's survival estimates by combining the benefits and harms of screening in one single measure.

The results are based on 100,000 women aged 50 and over surviving by year up to 20 years after entry to the screening programme.

Inclusion of false positives and unnecessary surgery reduced the benefits of screening by about half. The best estimates generated negative net QALYs for up to eight years after screening and minimal gains after 10 years.

After 20 years, net QALYs accumulate, but by much less than predicted by the Forrest report.

The authors say more research is needed on the extent of unnecessary treatment and its impact on quality of life. They also call for improved ways of identifying those most likely to benefit from surgery and for measuring the levels and duration of the harms from surgery. From a public perspective, the meaning and implications of overdiagnosis and overtreatment need to be much better explained and communicated to any woman considering screening, they add.

However, the continuing uncertainty surrounding the extent of overtreatment is apparent in a study of French women published on bmj.com last month, which put overdiagnosis of invasive breast cancer due to screening at around 1%.

Contacts and sources:
Emma Dickinson
BMJ-British Medical Journal

Tuesday 6 December 2011

14 Proven Side Effects of Sitting All Day

Original article can be found here

It should come as no surprise that sitting around and not moving all day isn't really good for your body, but many may not be aware of just how many problems can be caused by such a sedentary lifestyle. Whether you choose to sit all day or are required to by the logistics of your job, you may want to take a new approach to your workday after learning just what health effects sitting can have on the body. It could impact not only your health, but the lives of your loved ones and expenditures towards healthcare.

  1. Deep Vein Thrombosis. Most are familiar with this condition through warnings urging people not to sit without getting up on long flights. The same goes for sitting for hours on end anywhere– at work or at home– without moving. If you don't get up and walk around occasionally, you could be putting yourself at risk of potentially deadly blood clots in your legs.
  2. Obesity. Surprise, surprise, sitting all day rather than standing or moving around can play a contributing role in obesity. While not burning enough calories is part of the problem, studies have also shown that being overly sedentary can slow your metabolism and change how your body functions, further contributing to weight gain.
  3. Increased Risk of Heart Disease. You think a workout after work is enough to make up for sitting still all day? Think again. New studies have shown that exercise once a day, even for an hour, isn't enough to make up for sitting all day at work. Those who work out and sit all day are just as likely to develop heart disease as those who don't work out and sit all day, something that should make any health conscious worker reevaluate their daily schedule.
  4. Risk of Diabetes. Along with an increased risk of heart disease, sitting for prolonged periods of time can increase your chances of developing diabetes by as much as 7 percent. Why? Sitting all day actually causes your body to slow down considerably and can result in increased blood sugar (since your body doesn't need the sugar for energy it simply stays in your system), insulin resistance and a much less healthy you.
  5. Raised Cholesterol. Those standing desks and treadmills desks won't sound so bad after you learn what other side effects sitting all day can have. Not only will it raise your blood sugar, but your cholesterol as well. Sitting causes enzyme activity in the body to drop by as much as 90%, preventing those helpful enzymes from grabbing that fat and using it for energy. In fact, after a few hours of sitting, healthy cholesterol plummets by 20%.
  6. Herniated Disk. Our bodies aren't really designed to sit all day long. Sitting puts a lot of pressure on your hips and spine, and can lead to some injuries in them over an extended period of time. One such injury may be a herniated disk. Continued pressure on your spine may cause a disk to come out of place, creating a painful condition that can require medication, physical therapy or even surgery.
  7. Poor Posture. Do you always sit correctly when you're sitting down at work or at home? More than likely you're not, which can put undue pressure on certain parts of your body and lead to poor posture even when you're not sitting at a desk. Weakened muscles and tight joints caused by prolonged sitting take their toll over time, and can leave you feeling tired, cause extreme lower back and neck pain and harm your body as a whole.
  8. Knee Pain. When you sit, your knees are generally at a ninety degree angle. At first, this doesn't seem so bad, but after sitting all day, for weeks on end, this can take its toll on your knees. Sitting in this position puts pressure on the kneecap and can lead to pain and swelling and may result in having to wear a knee brace while at work.
  9. Muscle Weakness. It makes sense that moving less results in loss of muscle mass and muscle weakness. One of the hardest hit muscles is the gluteus maximums, or the buttocks. It is one of the largest muscles in the body and plays a big role in just about any movement you could want to do, so it's essential that it stays strong. Weak gluteus muscles can result in lower back pain and hip bursitis as well.
  10. Increased Risk of Depression. Sitting at your desk all day may make you depressed through the sheer tedium of it all, but there's a scientific reason for it as well. Reduced movement means less blood flow. Less blood flow means fewer feel-good hormones are moving through your body, helping you keep depression at bay. The effects can be even worse for those who already struggle with or are more prone to depression.
  11. Slowed Metabolism. When you sit for an extended period of time, your body starts to slow and shut down on a metabolic level. Since you're not moving around, your circulation slows and you're burning fewer calories and fewer fat burning enzymes are moving through your body. All of this can lead to an overall slowed metabolism that can affect your energy levels and cause you to gain weight.
  12. Neck Problems. Many people who work at a computer extend their necks to see or bend them slightly when working. While over the short term this may not be a huge problem, but over long periods of time it can start to harm the muscles and joints in the neck and lead to pain even when you're not at work.
  13. Back Aches and Pain. One of the hardest hit parts of the body when you're sitting all day is the lower back. It is under a large amount of pressure and can begin to ache while at work and for hours afterward. While stretching, working out the muscles and moving around can all help, many sitting all day just don't realize how much they're hurting their backs and could face long term problems trying to get them back into shape.
  14. Shorter Life Span. Those who sit more than six hours a day are at an increased risk of early death from all causes, higher by an average 35% for women and 18% for men, for those who exercise. Those who don't exercise and sit all day are at a 94% higher risk of premature death for women, and a 48% higher risk for men. This is no joke for those who spend their days at a desk. Get up, get exercising and start reducing the effects of being sedentary before it's too late.