Pills, pills & even more pills

LA times Health section Aug 6th, 07 Under the influence states - FOR many Americans, a doctor's decision to prescribe medication is something of a sacred transaction. A physician considers the patient and symptoms and chooses the best drug for the job, drawing upon years of training and clinical experience. It is an exchange conducted in a hushed sanctuary, far from the heat and noise of the marketplace -- a place where cool judgment reigns. That sanctuary has been breached. Today, drug manufacturers do everything in their considerable power to ensure that their brand-name prescription medications are on the lips of patients and in the minds of physicians every time the two meet across an exam table. In 2006, drug-makers spent almost $5 billion to reach out to consumers with direct advertising. The world's pharmaceutical companies spend an estimated $19 billion annually to woo doctors (the US market size itself is 300B$).
The sales strategies are complex and enticements to doctors are many. More than all this, the worrying fact is that 40-100% specialists in panels & groups who write drug advisories have extensive financial ties with drug companies.
With that in the background, Let us take a look at a couple of examples

Peptic ulcers, H Pylori & antacids

Doctors Warren & Marshall were ridiculed for decades after they published papers stating that H Pylori a common bacterium is the cause of Peptic ulcers. Unlike others, they did not give up. After many years of struggle to get heard, fights with peers in the medical world & the highly profitable antacid drug industry hovering in the background, Dr Robin Warren & Barry Marshall were finally awarded the Nobel Prize in 2005.

New Scientist states - Working at the Royal Perth Hospital, Barry Marshall and Robin Warren established beyond all doubt in the 1980s that Helicobacter pylori causes stomach ulcers by infecting and aggravating the gut lining. Moreover, they showed that ulcers could be cured altogether by killing the bacteria with antibiotics. Hitherto, ulcers had been considered incurable. Instead, patients' symptoms were treated with a lifetime of drugs to reduce the acidity of the gut. The pair’s claims provoked a fierce backlash from the medical establishment, which held to the dogma that ulcers were brought on by stress and lifestyle, and could not be cured. By revealing a simple cure, the researchers also threatened to destroy huge and lucrative global markets for the existing anti-ulcer drugs, which simply eased symptoms. At conferences, the two scientists were subjected to abuse and ridicule. Notably, Marshall proved in 1985 that the bacteria caused gastric inflammation by infecting himself, then curing his condition with antibiotics. Since their discovery, it has been accepted beyond all dispute that H. pylori causes more than 90% of duodenal ulcers and 80% of gastric ulcers.
Note the following - A peptic ulcer is a sore in the lining of the stomach or duodenum. The majority of peptic ulcers are caused by the H. pylori bacterium. Many of the other cases are caused by NSAID’s. None are caused by spicy food or stress. Treatment is still complex, antacids & acid suppressors & lining shields are required for acid reduction, antibiotics for the bacteria. Treatments could very well be double, triple or quadruple combinations of the above.
Although the idea that bacteria cause chronic inflammatory disease was seen as heresy back in the 1980s, there is now increasing evidence that bacteria might be to blame for other conditions, such as Crohn’s disease, rheumatoid arthritis and even the clogging of arteries that leads to coronary heart disease.
Peridontitis and CHD (Coronary heart disease)
This particular discussion has both supporters and detractors and proof is not absolute. Colgate for example has a white paper establishing the connection. The national advisory I thought agreed with this. AHA journal paper affirms - Periodontitis, which would lead to frequent bacteremia from the oral lesions, has been implicated as a risk factor for the development of cardiovascular disease. BTW I must state here that CHD has multiple causes and oral ill health is only one of them!!
Chronic inflammation from any source is associated with increased cardiovascular risk," Dr. Wolfgang Koenig, of the University of Ulm Medical Center, Germany, and colleagues write. "Periodontitis is a possible trigger of chronic inflammation."
In 1996 Dr. Joseph B Muhlestein at the University of Utah reported a startling discovery. His research team found a bacterium called Chlamydia pneumoniae in 79 percent of patients undergoing coronary bypass surgery. Now a report from Johns Hopkins says other studies have also implicated Chlamydia pneumoniae. In addition, the bacterium H pylori that causes the majority of stomach ulcers has been linked to CHD along with infectious agents that cause periodontal disease. Many laughed when it was first announced H pylori triggered stomach ulcers. How can bacteria cause heart attacks? Harvard researchers believe chronic infection, such as periodontal disease, causes inflammation that often goes unnoticed by patients. Inflammation is usually a helpful reaction because it sends an army of white cells to fight the infection. The Harvard report claims these inflammatory cells also secrete a substance called C-reactive protein (CRP). This, they believe, promotes the growth of atherosclerosis. Researchers also found men with the highest levels of CRP had three times as many heart attacks as those with the lowest levels.

On the other hand, A Swedish study by Dr Ahmadreza Parsa does provide another explanation for an association between periodontitis and cardiovascular disease, i.e. that chronic inflammation in the mouth leads to elevated levels of cholesterol in plasma. "

Statins – The miracle drug of the century
Serum cholesterol is a fat-like substance found in the blood (serum) and produced by the liver. The body needs a certain amount of cholesterol to build cell membranes and for other uses. However, the liver makes enough cholesterol to meet these needs. A diet high in saturated fats, trans fats and cholesterol tends to raise total blood cholesterol, while a diet low in those fats and dietary cholesterol helps to lower it. The risk of heart and blood vessel disease rises as blood cholesterol levels increase. Statins are a class of drugs that lower the amount of cholesterol in the blood. Lipitor and Zocor are examples.

Would it turn out that bacteria are a primary cause of CHD and that reduction or elimination of those would result in improving cardiac health? Most definitely!!

So then, what could happen to the highly profitable and growing Statin industry (The Statin industry is over 25Billion US dollars in size) in such a case?

Would it grow or decline? Food for thought!!!

I must add that I am neither from the anti Statin lobby nor am I against periodontal treatment, just wondering about all this!!

Something interesting - do you remember the much hyped bird flu hysteria?? How many of you know that the chairman of the Tamiflu (the only medicine for Bird flu) company Gilead Sciences Inc was Donald Rumsfeld till he became US defense secretary. They own the license though marketing is sublet to Roche. Maneka Gandhi’s article on how the hysteria was whipped up makes very interesting reading.

By the way here is something new for those medically inclined - Gut check RFID smart pills - This $500 device doesn't deliver drugs; rather, it provides information about acidity, pressure, temperature, and digestive activity from inside your intestines. The data is transmitted wirelessly via RFID to a receiver worn around the patient's neck or waist; from there it can be downloaded to a doctor's laptop.

I tell you guys - Soon we are going to have embedded phones in our body – or maybe they will call them ‘distance communicators’, You can tell yourself – I need to talk to ‘so and so’ now and it will dial out or establish wireless communication through the net to somebody thousands of miles away..