Heart of the Matter

A government run health care program will be able to supply everybody with their daily drugs. A friend emails: "Taking this single pill will help you overcome YOUR lifestyle that is harming and or killing you."

"A single daily pill that combines aspirin and four blood pressure and cholesterol medicines has passed its first big test, potentially offering a cheap, simple way to prevent both heart disease and stroke." M. Marchione, AP http://news.yahoo.com/s/ap/20090330/ap_on_he_me/med_heart_polypill

Today the results of a study at Brigham & Women's Hospital supports a point of view you have held. Statins may indeed be added to our orange juice and Lactaid along with calcium and vitamins.

March 29, 2009, New York Times: "Cholesterol Drugs may Reduce Risk of Clots — New results from a large study suggest that the drugs known as statins may have a benefit beyond lowering cholesterol: reducing the risk of developing blood clots in the veins."

There seems to be considerable trouble with the Medicare program. Spending is out of control in some regions of the country and doctor reimbursement has never been satisfactory, let alone the fact that "Medicare is ratcheting down" payments. How is it possible for this or a similar system to explode in size and keep is current barely acceptable standards? Another government run system, the VA, is forever under attack for sub-standard practices. The politicians can't even establish mandatory funding for the VA! We better be careful what we ask of our government and when we ask.

An old friend emailed me: Our government was/is charged with protecting our:
Borders ..Hello...

Banks.....Hello

S&L..... Hello

Managing our country….Hello

What am I missing….

The primary problem is disjointed disaffected health care systems with different mandates linked together.

A citizen base that has unhealthy abysmal health habits that cannot be supported by shared revenue. And,yet living longer then ever. Financially unsustainable.

Hmmmm.

How will health care changes impact science? See link: http://tinyurl.com/cnyzk4

How will health issues, that cross political lines, be addressed under a change to government run health care? See link: http://tinyurl.com/clxuns

Odd things will happen with any sweeping change. For example, divorce will probably become common among elderly, if the current system continues, to protect the ever dwindling assets or to prevent impoverishment of the still healthy mate should nursing care be required.

Scientific advancement, better doctoring, a smarter population (think the success of smoking cessation programs), and comprehensive elderly care programs are extending life beyond anyone’s expectations and its expenses. Can we really expect any future financial gain from a change to our health care system?

It is great to have good genes. I am envious. It isn't quite as good as all that however. Although you have an advantage, it is not a guarantee. A recent study looked at the paradox of people with high HDL who still have heart attacks and concluded that it is not better to have HDL>100 than it is to have HDL >65 and may be slightly worse. It seems that in some people high fat intakes are reflected in higher than normal HDL. It would probably be better to eat less saturated fat and have an HDL in the 70's or 80's.
And speaking of exercise, it is probably the single most important thing for overall health. We were evolved to exercise and everything from Alzheimer's to cancer is less frequent in people who exercise regularly.
Complacency always comes with a price.
tom

I also have a HDL of >100 and was interested in participating in any study to help with research and to find out more for myself. My understanding is that it is not common to have HDL >100, so I thought I'd help if possible. I try to eat healthy, but do not obsess over counting except with sugar. I do not work out, weigh 120-125lbs, and am 27.

The formulation doesn't matter. The liquid is a bit cheaper but it is all cheap and swallowing teaspoonfuls of that stuff gives me bad flashbacks to childhood as well.

Tom

I remember the worst thing about getting sick and staying home from school was being "forced" to take the required dose of fish oil. I think of fish oil as a medicine for children. Reading this I get the sense it's perfect for retired people spending their day watching Wall Street fall apart. I wonder which oil is best for the latter group: liquid, softgel or solid pill? Jonathan, thanks for the TJ's tip. I also wonder what other natural products might assist with the high BP & triglides/choles troubles of the knuckle-gnawing set?

incidentally, my Dr. recommended Trader Joe's brand. They are inexpensive and effective.

My primary care physician recommended fish oil and I have been taking it for about six months. My latest labs showed positive results.

Mahlerscom:

As always, the devil is in the details. Why arent you on a statin? Lovastatin is generic as is Simvastatin and probably not a lot more than Gemfibrizole. also Crestor is relatively inexpensive. Most of these are relatively flat priced so you could buy the biggest pill they sell and break it in pieces if you have tried 3 grams of fish oil (that is 3 grams of EPA and DHEA combined) and it is not working, another choice would be NIASPAN. unfortunately, that is not cheap and can't be broken up. Check with the pharmacy about pricing. Another choice is every other day Statin which works for the longer acting ones, Simvastatin and Crestor (Rosuvastatin).

But before you make ANY changes, be sure to consult with your primary care physician first.

Good luck,
Tom Sbarra

Question: Since I take "Lopid" aka "Gemfribrizol" and my Cholesterol is below 200, but the good is low and the bad is high and I rarely eat "bad" food, fish oil is not working, what can I do with the least amount of $$$$$ to change those levels doc?

Thanks

First, kudos to those fine people that work with you in drug tests. Next, I'd like to make clear that my reference to "professional pill poppers" is in regard to the early drug trials conducted by drug companies period. Your articles are thought provoking and valuable and my remarks are simply postscripts of little value; but, I sincerely appreciate your reading and commenting back. What Bush did was decimate the policing and oversight departments within the government that were so important to providing safety to the public. You are correct Reagan blazed the awful path to deregulation. Here, let me give you my first hand experience with harmful, over-marketed, poorly regulated, inappropriately tested drugs: bisphosphonates - Actonel, Fosamax and Boniva. One word serves to describe the drug companies, SHAME. All new drugs should go into a final test phase with a significant and varied sized group of medical doctors before going public, for which they would, of course, we warmly compensated. If doctors earn their living prescribing them, they ought to be willing to test, analyze, and report on these drugs.

I think you should have your own health blog site. I share your disgust with the regulatory environment but as it turns out the heart meds doctors are, in your words, 'pushing' were approved in the 1988-92 time frame in the wake of the Regan deregulation frenzy. so, although we can blame lots of things on the current Bush, this pattern has been around for a while. The REAL problem is that Regan and the first Bush gutted the budget for the NIH, effectively bringing objective research to a screeching halt and allowing drug companies to design and fund their own studies with expected results. You have given me an idea for a future article.

By the way, I have recruited many patients for well designed trials and they were not 'professional pill poppers' but just well intended altruistic folks to whom I am very grateful.

Comment 2 of 2: The most dramatic change in lifestyle was the reduced level of exercise over life in Japan and the increased volume of food consumed in the U.S.. Sadly, the Japanese remain today heavy smokers. It may yet be proven that the death rate from coronary heart disease is caused by living longer and stressful living and not so much by cholesterol. Still, Monsieur Cholesterol, Dr. Keys, did marvelous breakthrough research. Our continued attention to his diet warnings remain prudent (no longer do people butter their cheese). Keys taught us that fat is bad. But, his critics claim he "cherry picked" data and today the cholesterol controversy remains. One hundred years later the U.S. has a worsening obesity and diabetes problem. It remains an undisputed fact that we're all gonna die. The drug companies have already mounted a national effort to lower cholesterol. It would be unwise to put added emphasis and resources into this area until a new President can correct the terrible problems within the FDA, NIH, and initiate safer control of public drug use.

Comment 1 of 2: Dr. Ancel Keys was born in Colorado Springs in 1904 and lived to be 100. Growing up he worked in a lumber camp, renown for its prodigious consumption of meat and a Woolworth store, famous for it's fast food counter service. Keys went on to learn the importance of fruits in the daily diet. From what I can tell, his studies on Japanese residents in 1956 in Japan and the U.S. were deeply flawed. His reports on cholesterol in the 1950's lacked any in depth analysis of the daily diet. Although Keys was based at the University of Minnesota, a control group was located in Madison, Wisconsin. In those days, Japanese stuck religiously to their native diet - indeed they continue to do so today even if 2nd or 3rd generation. Those Japanese that returned to Madison as war brides, who had husbands that refused to eat traditional Japanese food, would prepare two meals nightly, one for Dad and the kids and one for Mom - Japanese food. Those Japanese on staff and that were students at UW also held closely to their food tradition. In CA and HI the ability to stick with a pure Japanese diet was more pronounced.

To continue the discussion from the first of the cholesterol series, I feel the move toward more aggressive treatment would best be accomplished with all due sluggishness. We have a pill problem in this country, it's dangerous, and more caution and re-regulation is needed. Nursenancy is correct, in my opinion, that "the problem is that doctors aren't listening to their patients". This compounds the problem caused by Big Pharma becoming king of the mountain while the deposed FDA muddles in a no-where-land of disengagement. This has left the public at risk. The package inserts passed out with drugs are nothing more than a drug company system, approved by the two Bush Administrations, to bypass what used to be, judicial controls. The current system is too dangerous for doctors to urge more aggressive use of drugs. The professional pill poppers used in trials in no way protects the public. The data acquired by the trials in no way accounts for all the information, printed in tiny type, on the package inserts - the kitchen sink is tossed in. As a consequence, consumers treat the information as boilerplate pabulum. Buyer beware.

See my next posting which addresses some of these issues. The answer is you may have a genetic makeup that gives you high cholesterol and fortunately, high HDL. This would look different ( and worse) if you did not have a healthy lifestyle( i.e. if you ate whatever you wanted and did not exercise a lot).
Unfortunately, this profile is not a guarantee to live forever. Despite widespread notions that very high HDL is completely protective, it is not.
You do need to pay attention and should investigate this further before becoming too complacent.

Is there a way to participate in a study on this type of thing? I am a triathlete and runner who has 277 choleststerol. My hdl is 107 and ldl 161. While not perfect, my diet is very healthy w/ numerous fruits, veggies, fish, and very little red meat. I've always wanted to understand why my cholesterol is so high, and should I be taking medicine? I'm anti medicine and would prefer not to.

The problem here is that some doctors aren't listening to their patients in that short routine visit.When someone is complaining on muscle soreness and saying that they are finding that they can't get moving without alot of effort,this should send out a white flag to review meds.I have a friend on Lipitor and it took two visits with the Doctor and finally a visit with the nurse practioner to stop the medicine and realize that this was causing her problem.
We need to listen more to our bodies and report changes.And in turn our healthcare professionals need to listen to us.

Your points are well taken. clearly modern medicines are powerful and have powerful side effects. there is a bit of 'buyer beware' mentality in the system although there are package inserts, the internet, doctors and pharmacists who will help you understand the drugs and side effects. My experience is that the people who most get into trouble are taking multiple medications that interact or who have unusual and therefore unexpected side effects. they tend to have symptoms for a long time and sometimes get quite sick before the cause if fugured out. if you get symptoms that you have not had before you should contact your doctor ASAP to sort it out. prudently, most doctors will stop medications for a time to see if the symptoms clear up.

Tom Sbarra

Beware of excessive use (indeed any use) of prescribed drugs. For example, one Boniva pill can devastate the good health of a person and bring tragedy to their life. Statins, especially long term use, can cause many troubling problems. Buyer beware! The two Bush Administrations have neutered the oversight and regulatory departments in the FDA. Recent legislation protects Big Pharma from getting sued. The FDA has let the drug companies put the long sheets of six point type, given at the time a prescription is filled, in between the pill consumer and the right to seek justice through the courts, should your life get destroyed by a pill. Be informed and make the decision to medicate yourself only after prudent review of the available information. The cozy relationship of drug companies with doctors would suggest the consumer should first search for all relevant data before swallowing. One site that gives pill user feedback is www.askapatient.com.

government controlled health care?-
soon bailing out physicians,how dare!-
the same crew that ran macfreddy?-
count me out-
I'm not ready-

The health care system is broken. Before we nationalize health care, it needs to be fixed. John McCain has proposed that as part of his health care plan.

Reforming Medicaid/Medicare, coordinated care, tort reform, information technology upgrades, transparency and development of national standards.

A magickal blend of smugness and despair, wrapped in a yachting blazer! It may be somthing more fluid than politics that clouds ham- er, possee's perception...
possee [Member] writes:
Buzz
Given the latest escapades of our illustrious politicians..
I give no credence to either candidate nor party..
They are all modern day fleece merchants...
selling us a bill of goods to obtain our vote then make us pay...dearly!
Health care, jobs, reinventing govt, etc etc are all , excuse the expression, "buzz" words..
I am leaving out politics as it just clouds my perception..
rather enjoy an evening of solitude and the rest of my life without their nonsense and total bs...

Buzz...reform it? How? He's clueless, his healthcare plan will TAX your healthcare dollars and pay $5000 directly to your insurance company. If you think that $5000 is going to buy you 1/10 of what you need for healthcare costs, you're living on mars.

Buzz

Given the latest escapades of our illustrious politicians..
I give no credence to either candidate nor party..
They are all modern day fleece merchants...
selling us a bill of goods to obtain our vote then make us pay...dearly!
Health care, jobs, reinventing govt, etc etc are all , excuse the expression, "buzz" words..

I am leaving out politics as it just clouds my perception..

rather enjoy an evening of solitude and the rest of my life without their nonsense and total bs...

McCain would like to reform health care to get the costs down before implementing a national health care program. What do you think about that?

I don't know about govt healthcare given their disastrous handling of our monies in every other venture..
Let's hope there are no penalties for going outside the system,
We need and demand a choice without govt interference or penalties.

possee

Agree, the Obama plan makes the most sense from the financial and personal care/access perspectives. A nation as big as ours trying to tackle the health care problem is going to have to stumble its way forward. Obama has a good beginning.

It's all over-no Hawaiian. This from the Japan Times today. Hakuho wins, secures eighth Emperor's Cup Kyodo News Mongolian yokozuna Hakuho defeated ozeki Kotooshu to capture his eighth championship title on the penultimate day of the Autumn Grand Sumo Tournament on Saturday. Closest rivals ozeki Kotomitsuki and sekiwake Ama both suffered third losses at Ryogoku Kokugikan in Tokyo and Hakuho took full advantage in the day's finale, outmuscling Bulgarian Kotooshu to clinch the Emperor's Cup with his 13th win.

If you examine the fine print of the McCain health plan, you see that Sect. 155688 maintains that "long-term patients will be smashed in the face with rifle butts by their Vietcong captors."

On non-Japanese at the current sumo round in Tokyo, The Daily Yomiuri reports: Earlier Tuesday, Asashoryu of Mongolia pulled out of the meet with an injured left elbow. Veteran grappler Kaio used an arm throw to send fellow ozeki Kotooshu of Bulgaria over the straw ridge.

I was just kicking ass on Madden last night.... franchise mode, jigga!

It's all about having money doc. If those finger lick'n chicken eaters had the loot, ya can't beat the sushi in Paradise. As you know, the Japanese live longest - good nutrition. Not a lot of Hawaiians in the makuuchi division or reaching the rank of yokozuna - only Akebono. Finger lick'n chicken eaters are charging into the dohyo are Mongolian, Georgian, Russian, and Bulgarian. Wow, flat world, not much money.

While seeking a "cure for cancer" seems to be the Holy Grail, a cure for fatness - swallow a pill and you can eat just about anything without gaining weight - may soon become a higher priority for our society. Does anybody dispute that "fitness" is a non existent concept among the folks discussed in this post. Diabetes is running rampant among the poor because of their carbo intake. That's not going to change. So until the much maligned drug companies find a solution, things will get worse before they get any better.
Thanks Doc for an informative post.

"Exercise" for Ned means "eats with both hands."

Wow, a Size Acceptance article at CCToday! Just got off the phone with my new plus-size sweetie who exercises fanatically... an awesome bounciness like a fresh pear you wanna bite into... fit fat folk rule.

The advent of cheap firearms really made "being in shape" more of a lifestyle option than a necessity.

Natural sugars don't create havoc with the human system..
it' s the processed crap most eat and drink that reeks havoc..

simple science folks