Study Suggests It Is Cost-Effective to Distribute Naloxone Kits to Heroin Users.


Distributing kits containing the opioid antagonist naloxone to heroin users to treat witnessed overdoses would be cost-effective, according to an analysis in the Annals of Internal Medicine.

Researchers modeled the experience of a hypothetical 21-year-old novice user, based on epidemiologic data regarding overdose rates, mortality, and stopping use. They estimated that providing the kits to 20% of such users would prevent roughly 7% of all overdose deaths. Roughly 160 kits would need to be distributed to prevent one overdose death. The authors conclude such a strategy would be cost-effective, with a worst-case scenario of an estimated $14,000 per quality-adjusted life-year gained.

Source: Annals of Internal Medicine.

Amgen Agrees to Pay $762 Million in Drug Marketing Case.


drug-pays

In recent years, drug companies have paid out billions in fines to settle various federal, state and civil lawsuits.

Among the charges is promoting drugs illegally for off label use, which is common, even when it puts patients lives at risk.

It’s been said that imposing fines – even those that approach $1 billion or more – is simply not enough to deter this type of criminal behavior, as the drug company executives sitting at the helm are not held personally accountable (or subject to personal prosecution) and jail time.

This appears to be precisely the case, as time and time again drug companies are allowed to promote drugs for uses that could actually harm patients, or engage in other illegal, criminal activities, and they receive what amounts to a slap on the wrist as punishment.

Two drug giants, Amgen and Sanofi, are the latest to add hundreds of millions in settlement monies to the growing stash …

Amgen to Pay $762 Million in Criminal Penalties for Illegal Drug Marketing

According to one U.S. attorney, Amgen was “pursuing profits at the risk of patient safety”1 by selling and promoting the drug for unapproved uses. Prosecutors alleged that Amgen had promoted the anemia drug Aranesp to treat cancer patients not undergoing chemotherapy (the drug is only approved for those receiving chemotherapy). A later Amgen study actually showed that giving cancer patients who were not receiving chemo Aranesp increased their risk of death.

The company also was federally charged with promoting larger, but less frequent, injections of Aranesp as a way to edge out competing drugs – even though the U.S. Food and Drug Administration (FDA) had turned down Amgen’s requests for this approval, citing inadequate safety studies. In fact, one study actually found giving the drug at higher doses may increase cardiovascular risks …

Drug Promoted Off-Label Despite Research Showing Increased Heart Risks

In 1998, the Normal Hematocrit Trial was published, which explored giving higher doses of drugs to dialysis patients in order to boost their red blood cell count above those generally achieved with transfusion.2 The study found that patients receiving the higher drug dose were dying or having heart attacks at a higher rate than those receiving the lower dose; the trial was actually halted because of this.

However, rather than sounding an alarm bell, when the study was published the authors downplayed the danger, calling the increased death and heart attack rate “not significant.” And while no difference was found in quality of life between patients receiving the higher or lower dose, this was not noted in the published study. (Four of the study’s eight authors were employed by Amgen, and two have served as consultants.)

As the years went by, health care providers and the drug companies continued to profit from the ever-rising doses of these drugs being prescribed – despite continued studies coming out questioning their safety. It wasn’t until years later, in 2011, that the FDA put out a safety announcement calling for more conservative dosing of the drugs “because of data showing increased risks of cardiovascular events.”3

The New York Times further reported on Amgen’s charges:4

“A document summarizing the charges says that while sales representatives were not supposed to initiate discussions of off-label uses, they were trained to elicit questions from doctors. Such questions would provide the “necessary cover” for the sales representatives to provide the doctor with studies supporting the off-label use. Amgen referred to this as “reactive” marketing, the document said.

Amgen also managed to list the unapproved uses in a reference called a compendium. Medicare is required to pay for off-label uses of cancer drugs listed in an approved compendium. The compendium system is intended to make drugs more easily available to cancer patients, but critics say the compendiums do not adequately review the evidence.”

To settle the charges, Amgen has agreed to pay $612 million for civil litigation, along with $136 million in criminal fines and forfeit $14 million. The company has also agreed to sign a Corporate Integrity Agreement that requires executives to certify compliance with regulations, which would theoretically make it easier to prosecute them personally for any future offense. This is, unfortunately, just the latest drug scandal to be brought to the public’s attention… and it surely won’t be the last.

Sanofi to Pay $109 Million to Settle U.S. Kickback Charges

You might remember drug maker Sanofi, as I recently ran articles on them describing the revolving door between federal agencies and the drug companies. The chief and major science officer from the U.S. National Institutes of Health (NIH) took jobs at Sanofi as their president and chief scientific officer. Now the company has agreed to pay $109 million to resolve allegations that it gave free drugs to physicians as a form of kickbacks, which violates the False Claims Act.

The company allegedly gave out thousands of free “samples” of the arthritis drug Hyalgan that were contingent on future purchases and essentially used to lower the drug’s effective price. Sanofi then submitted false average sales price reports, which are used to determine reimbursements rates from Medicare and other government health programs, thereby causing the government to pay inflated rates for the drug.5

In this case no criminal charges were filed and, other than the paltry $109 million settlement, Sanofi only has to enter into a Corporate Integrity Agreement with the government that is supposed to leave them under enhanced scrutiny.

The Top 10 Drug Company Settlements

Big Pharma lawsuits, especially those that settle in the hundreds of millions or billions, are intended to compel these criminal corporations to straighten out, abandon their fraud and deception, their kickbacks, price-setting, bribery and all other illegal sales activities in favor of looking out for public health, which to date has been clearly ineffective.

Most of these settlements amount to a mere slap on the wrist for the drug company, which typically will continue right along with their deceitful behaviors. This is evidenced by the stunning frequency with which these major settlements occur:6

  1. 2007: Bristol-Myers Squibb paid $515 million for illegally promoting its atypical antipsychotic drug Abilify to kids and seniors (despite a black box warning that warned of potentially fatal side effects in the elderly). Other accusations included giving payments, kickbacks and expensive vacations to medical professionals and pharmacist to dispense its drugs.
  1. 2010: AstraZeneca settled for $520 million for trying to persuade doctors to prescribe its psychotropic drug Seroquel for unapproved uses ranging from Alzheimer’s disease and ADHD to sleeplessness and post-traumatic stress disorder (PTSD). Using Seroquel for improper use has been linked to an increased risk of death.

Company executives also promoted the drug for weight loss, highlighting one favorable study while burying others that linked it to substantial weight gain.

  1. 2007: Purdue Pharma paid $634.5 million for fraudulently misbranding Oxycontin, and suggesting it was less addictive and less abused than other painkillers. The company was charged with using misleading sales tactics, minimizing risks and promoting it for uses for which it was not appropriately studied.
  1. 2012: Amgen, the makers of anemia drugs Aranesp and Epogen, has been accused of handing extra profits to doctors who prescribe the drugs (by overfilling vials, then allowing doctors to charge insurance companies for drugs they got for free). Other accusations include misconduct involving claims of safety and efficacy, marketing, pricing and dosing of the drugs. Amgen has agreed to pay $762 million to settle the suits.
  1. 2011: Merck settles for $950 million to resolve fraudulent marketing allegations and safety claims related to Vioxx. Vioxx was pulled from the market in 2004, after it was shown to double the risk of heart attack and stroke. In addition to the $950 million, Merck paid hundreds of millions more to harmed patients and their families (Vioxx contributed to causing heart attacks in up to 140,000 people, half of which were fatal).
  1. 2009: Eli Lilly pays $1.4 billion for promoting Zyprexa for off-label uses, often to children and the elderly, and not properly divulging side effect information. For instance, Zyprexa was marketed as a sleeping aid for the elderly because one of its side effects is sedation, even though the drug also increases the risk of death.
  1. 2012: Abbott Laboratories settles for $1.5 billion for aggressively promoting their seizure drug Depakote for off-label use in elderly dementia patients, despite lacking evidence of safety or effectiveness (and a known increase of serious side effects, like anorexia, in the elderly).
  1. Currently pending: Johnson & Johnson will pay anywhere from $1.5 to $2 billion for illegal marketing of Risperdal and other drugs. The company not only heavily marketed drugs to children and the elderly despite inadequate evidence of safety or efficacy, they also hid data about drugs’ side effects.
  1. 2009: Pfizer pays $2.3 billion for marketing fraud related to Bextra, Lyrica and other drugs. Charges included marketing drugs to doctors for uses for which they had not been approved and giving kickbacks to doctors and other health care professionals for prescribing their drugs. This was Pfizer’s fourth settlement numbering in the multimillions in less than a decade.
  1. 2012: GlaxoSmithKline (GSK) to pay $3 billion for illegal marketing of Paxil and Welbutrin and downplaying safety risks of Avandia, among other charges. The company hid data about drug risks, marketed drugs for unapproved uses, and paid doctors (or gave them lavish gifts like expensive vacations) for prescribing their drugs. One of the most high-profile accounts involved television celebrity Dr. Drew, who reportedly received $275,000 from GSK to promote Welbutrin to treat sexual dysfunction associated with depression even though it hasn’t been proven effective for this purpose.

Are You Putting Your Health in the Hands of Criminals?

If you rely on drugs to stay well, or believe that if you get sick one day you’ll simply take a medication to “get better,” it’s worth recognizing that the same companies that are manufacturing and promoting those drugs have probably been convicted of criminal and fraudulent charges. You might want to reconsider your decision in light of these circumstances.

Putting your health, your very life, in the hands of these drug companies is a frightening prospect because the leading pharmaceutical companies are also among the largest corporate criminals in the world, often behaving as if they are little more than white-collar drug dealers. As these companies have shown time and again, they consistently put profits above human health … and this includes your health.

Adding salt to the wound, most of the top-selling drugs treat conditions that are better treated with lifestyle changes, healthy food and other forms of natural healing!

Source: Dr. Mercola

Before incubation, a coworking space for start-up conception.


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It is a large “coworking” office finely tuned to the requirements of people who need space to dream about their start-ups, to be creative, to find like-minded individuals just to hash out ideas, to find partners, to take constructive breaks in a comfortable environment.

Coming here costs US$125 a month, a considerably smaller fee than coworking spaces in other metropolises. Members who use the space, called CoCoon, do not need to have a start-up, but they have to have a good idea or a useful skill, and be interested in interacting with other members to build a kind of supportive community that is said to be sorely lacking in Hong Kong.

CoCoon occupies the third floor of a shiny office building. Its main founder, Max Ma, who is in the jewelry retail business, owns the space.

He said he hopes it will help entrepreneurs build small and medium-size businesses that will create employment in Hong Kong — a city where giant conglomerates run most of the show and the wealth gap is the highest among all developed economies in the world, according to UN stats.

“This is my small contribution to Hong Kong,” said Ma, whose children Theodore and Erica Ma, also entrepreneurs, help oversee CoCoon. If leased out, the space’s monthly rent would be US$25,000, he said.

When CoCoon meets its goal of having 400 paying members, it is expected to recoup all costs — but Theodore Ma stresses that costs are beside the point; the most important factor for them is maintaining high-quality members, hosting useful events and helping start-ups that will be meaningful.

“Only when our entrepreneurs succeed in satisfying their customers and users will Cocoon truly
become profitable and meaningful in the long term,” he said in an e-mail.

Having opened its doors for less than two months, CoCoon is still working on screening and accepting members, or “tenants.” An application process helps identify who would have something to offer.

The group is looking for entrepreneurs, investors who would also act as seasoned mentors, and people who can offer skills like programming or graphic design. These varied members often come here looking for partners.

In space-tight Hong Kong, CoCoon is refreshingly bright, airy and open. The main working area, taking up half the floor, is sparsely populated with large desks — no cubicles in sight. A long row of metal lockers line one of the walls, high-school style. Small office-type rooms are in the back for making the occasional loud phone calls.

The other half of the space features a coffee bar, ping-pong table, foosball table, a meditation room with three bean-bag chairs (chairs are generally all over the place) and a library of start-up and tech-related books.

“We have foosball and ping pong, because watching fast-moving objects is supposed to provide good eye exercise,” especially for workers staring at computers all day, said Darren Yung, a manager at CoCoon.

Some of the wall space is covered in bright orange dry-erase boards, where ideas, inspiration and job openings get shared. The place’s other accent color motif is the techland favorite Android green.

But other than enviable toys and ample breathing room, CoCoon offers support for innovation, something that entrepreneurs says is rather deficient in Hong Kong.

Rayfil Wong comes here to work on his project, a children’s self-help book for the iPad. He laments that the government provides only scant funding for technology and is not doing enough to encourage innovation.

“There is a lack of motivation and constant fear,” he said, adding that individuals are reluctant to step out and do something innovative.

Tenants at CoCoon say Hong Kong’s obsession with its banks is, as usual, part of the blame. “Because of the booming financial industry, a lot of talent gets sucked into those sectors,” said Vicky Wu, a former banker who co-founder of ZaoZao, a crowd-funding website for fashion designers that is set to launch at the end of this month.

For example, Wu said, local graduates in programming make a beeline for operations and tech support jobs at banks. This makes it hard for start-ups to find programmers on a project basis. But CoCoon aims to fill some of that gap by helping to connect freelancers with small business people.

Wu and her partner, Ling Cai, were CoCoon’s first tenants. But their days spent here are nearing an end, as ZaoZao has been accepted into Science Park, a bona fide incubator that provides space — and much coveted government funding. Giving entrepreneurs the means to progress in their start-ups is one of CoCoon’s goals — and ZaoZao has become one of CoCoon’s first success stories.

Source: Smart planet

Soybean Oil: One of the Most Harmful Ingredients in Processed Foods.


Processed food is perhaps the most damaging aspect of most people’s diet, contributing to poor health and chronic disease. One of the primary culprits is high fructose corn syrup (HFCS), the dangers of which I touch on in virtually every article on diet I write.

The second culprit is partially hydrogenated soybean oil.

These two ingredients, either alone or in combination, can be found in virtually all processed foods and one can make a compelling argument that the reliance on these two foods is a primary contributing factor for most of the degenerative diseases attacking Americans today.

Part of the problem with partially hydrogenated soybean oil is the trans fat it contains. The other part relates to the health hazards of soy itself. And an added hazard factor is the fact that the majority of both corn and soybeans are genetically engineered.

As the negative health effects from trans fats have been identified and recognized, the agricultural- and food industry have scrambled to come up with new alternatives.

Partially hydrogenated soybean oil has been identified as the main culprit, and for good reason. Unfortunately, saturated fats are still mistakenly considered unhealthy by many health “experts,” so rather than embracing truly healthful tropical fats like coconut oil, which is mostly grown outside the US. The food industry has instead turned to domestic US alternatives offered by companies like Monsanto, which has developed modified soybeans that don’t require hydrogenation.

Why Hydrogenate?

Americans consume more than 28 billion pounds of edible oils annually, and soybean oil accounts for about 65 percent of it. About half of it is hydrogenated, as soybean oil is too unstable otherwise to be used in food manufacturing. One of the primary reasons for hydrogenating oil is to prolong its shelf life. Raw butter, for example, is likely to go rancid far quicker than margarine.

The process also makes the oil more stable and raises its melting point, which allows it to be used in various types of food processing that uses high temperatures.

Hydrogenated oil1 is made by forcing hydrogen gas into the oil at high pressure. Virtually any oil can be hydrogenated. Margarine is a good example, in which nearly half of the fat content is trans fat. The process that creates partially hydrogenated oil alters the chemical composition of essential fatty acids, such as reducing or removing linolenic acid, a highly reactive triunsaturated fatty acid, transforming it into the far less reactive linoleic acid, thereby greatly preventing oxidative rancidity when used in cooking.

In the late 1990’s, researchers began realizing this chemical alteration might actually have adverse health effects. Since then, scientists have verified this to the point of no dispute.

Beware that there’s a difference between “fully hydrogenated” and “partially hydrogenated” oils. Whereas partially hydrogenated oil contains trans fat, fully hydrogenated oil does not, as taking the hydrogenation process “all the way” continues the molecular transformation of the fatty acids from trans fat into saturated fatty acids. Fully hydrogenated soybean oil is still not a healthy choice however, for reasons I’ll explain below. The following slide presentation explains the technical aspects relating to the hydrogenation process.

The Health Hazards of Trans Fats Found in Partially Hydrogenated Oil

The completely unnatural man-made fats created through the partial hydrogenation process cause dysfunction and chaos in your body on a cellular level, and studies have linked trans-fats to:

Cancer, by interfering with enzymes your body uses to fight cancer Chronic health problems such as obesity, asthma, auto-immune disease, cancer, and bone degeneration
Diabetes, by interfering with the insulin receptors in your cell membranes Heart disease, by clogging your arteries (Among women with underlying coronary heart disease, eating trans-fats increased the risk of sudden cardiac arrest three-fold!)
Decreased immune function, by reducing your immune response Increase blood levels of low density lipoprotein (LDL), or “bad” cholesterol, while lowering levels of high density lipoprotein (HDL), or “good” cholesterol
Reproductive problems by interfering with enzymes needed to produce sex hormones Interfering with your body’s use of beneficial omega-3 fats

 

As usual, it took many years before conventional health recommendations caught up and began warning about the use of trans fats. Not surprisingly, as soon as the FDA required food manufacturers to list trans fat content on the label — which took effect on January 1, 2006 — the industry began searching for viable alternatives to appeal to consumers who increasingly began looking for the “No Trans Fat” designation. It didn’t take long before Monsanto had tinkered forth a genetically engineered soybean that is low in linolenic acid, which we’ll get to in a moment.

Beware that some food manufacturers have opted to simply fool buyers — a tactic allowed by the FDA as any product containing up to half a gram of trans fat per serving can still legally claim to have zero trans fat2. The trick is to reduce the serving size to bring it below this threshold. At times, this will result in unreasonably tiny serving sizes, so any time you check a label and a serving is something like 10 chips or one cookie, it probably contains trans fats.

The Health Hazards of Soybeans

Besides the health hazards related to the trans fats created by the partial hydrogenation process, soybean oil is, in and of itself, NOT a healthy oil. Add to that the fact that the majority of soy grown in the US is genetically engineered, which may have additional health consequences. When taken together, partially hydrogenated GE soybean oil becomes one of the absolute worst types of oils you can consume.

Years ago, tropical oils, such as palm and coconut oil, were commonly used in American food production. However, these are obviously not grown in the US. With the exception of Hawaii, our climate isn’t tropical enough. Spurred on by financial incentives, the industry devised a plan to shift the market from tropical oils to something more “home grown.” As a result, a movement was created to demonize and vilify tropical oils in order to replace them with domestically grown oils such as corn and soy.

The fat in soybean oil is primarily omega-6 fat. And while we do need some, it is rare for anyone to be deficient as it is pervasive in our diet. Americans in general consume FAR too much omega-6 in relation to omega-3 fat, primarily due to the excessive amount of omega-6 found in processed foods. Omega-6 fats are in nearly every animal food and many plants, so deficiencies are very rare. This omega-6 fat is also highly processed and therefore damaged, which compounds the problem of getting so much of it in your diet. The omega-6 found in soybean oil promotes chronic inflammation in your body, which is an underlying issue for virtually all chronic diseases.

What About Organic Soybean Oil?

Even if you were fortunate enough to find organic soybean oil, there are still several significant concerns that make it far from attractive from a health standpoint. Soy in and of itself, organically grown or not, contains a number of problematic components that can wreak havoc with your health, such as:

  • Goitrogens – Goitrogens, found in all unfermented soy whether it’s organic or not, are substances that block the synthesis of thyroid hormones and interfere with iodine metabolism, thereby interfering with your thyroid function.
  • Isoflavones: genistein and daidzein – Isoflavones are a type of phytoestrogen, which is a plant compound resembling human estrogen, which is why some recommend using soy therapeutically to treat symptoms of menopause. I believe the evidence is highly controversial and doubt it works. Typically, most of us are exposed to too much estrogen compounds and have a lower testosterone level than ideal, so it really is important to limit exposure to feminizing phytoestrogens. Even more importantly, there’s evidence it may disturb endocrine function, cause infertility, and promote breast cancer, which is definitely a significant concern.
  • Phytic acid — Phytates (phytic acid) bind to metal ions, preventing the absorption of certain minerals, including calcium, magnesium, iron, and zinc — all of which are co-factors for optimal biochemistry in your body. This is particularly problematic for vegetarians, because eating meat reduces the mineral-blocking effects of these phytates.

Sometimes it can be beneficial, especially in postmenopausal women and in most adult men because we tend to have levels of iron that are too high which can be a very potent oxidant and cause biological stress. However, phytic acid does not necessarily selectively inhibit just iron absorption; it inhibits all minerals. This is very important to remember, as many already suffer from mineral deficiencies from inadequate diets.

The soybean has one of the highest phytate levels of any grain or legume, and the phytates in soy are highly resistant to normal phytate-reducing techniques such as long, slow cooking. Only a long period of fermentation will significantly reduce the phytate content of soybeans.

  • Natural toxins known as “anti-nutrients” — Soy also contains other anti-nutritional factors such as saponins, soyatoxin, protease inhibitors, and oxalates. Some of these factors interfere with the enzymes you need to digest protein. While a small amount of anti-nutrients would not likely cause a problem, the amount of soy that many Americans are now eating is extremely high.
  • Hemagglutinin — Hemagglutinin is a clot-promoting substance that causes your red blood cells to clump together. These clumped cells are unable to properly absorb and distribute oxygen to your tissues.

Worst of All — Genetically Engineered Soybean Oil

The genetically engineered (GE) variety planted on over 90 percent of US soy acres is Roundup Ready — engineered to survive being doused with otherwise lethal amounts of Monsanto’s Roundup herbicide. The logic behind Roundup Ready crops such as soy is that you can decrease the cost of production by killing off everything except the actual soy plant.

However, animal studies reveal there may be significant adverse health effects from these GE soybeans, including progressively increased rates of infertility with each passing generation. By the third generation, virtually all the hamsters in one feeding study were found to be infertile. Second-generation hamsters raised on GE soy also had a five-fold higher infant mortality rate.

Are Low-Linolenic Soybeans the Answer?

We now also have other Monsanto-made soy crops to contend with. Responding to the growing demand for healthier diets, Monsanto launched Vistive low-linolenic soybeans in 2005. Most soybeans contain roughly seven percent linolenic acid. The new varieties contain one to three percent. As explained by Monsanto3:

“The oil from these beans can reduce or virtually eliminate trans fat in processed soybean oil… Vistive low-linolenic soybeans have lower levels of linolenic acid. Because of these lower levels, which were achieved through traditional breeding practices4, the oil produced by Vistive low-linolenic seeds does not require hydrogenation, the process that is used to increase shelf life and flavor stability in fried foods, baked goods, snack products and other processed foods.”

Yet another soybean variety created by Monsanto is the high stearate soybean, which also has the properties of margarine and shortening without hydrogenation. But are these soybeans any better or safer than either conventional soybeans or Roundup Ready soybeans, even though they don’t have to go through partial hydrogenation, and therefore do not contain trans fat? No one knows.

Another Hazard of GE Soybeans: Glyphosate

I keep stacking health risks upon health risks, and here’s another one: Research has shown that soybean oil from Roundup Ready soy is loaded with glyphosate, the main ingredient in Roundup — the broad-spectrum herbicide created by Monsanto.

According to a report in the journal Chemical Research in Toxicology, the highest MRL for glyphosate in food and feed products in the EU is 20 mg/kg. GE soybeans have been found to contain residue levels as high as 17 mg/kg, and malformations in frog and chicken embryos occurred at 2.03 mg/kg.5 That’s 10 times lower than the MRL.

This is an alarming finding because glyphosate is easily one of the world’s most overlooked poisons. Research published in 2010 showed that the chemical, which works by inhibiting an enzyme called EPSP synthase that is necessary for plants to grow, causes birth defects in frogs and chicken embryos at far lower levels than used in agricultural and garden applications.6 The malformations primarily affected the:

  • Skull
  • Face
  • Midline and developing brain
  • Spinal cord

When applied to crops, glyphosate becomes systemic throughout the plant, so it cannot be washed off. And once you eat this crop, the glyphosate ends up in your gut where it can decimate your beneficial bacteria. This can wreak havoc with your health as 80 percent of your immune system resides in your gut (GALT – Gut Associated Lymph Tissue) and is dependent on a healthy ratio of good and bad bacteria. Separate research has also uncovered the following effects from glyphosate:

Endocrine disruption DNA damage
Developmental toxicity Neurotoxicity
Reproductive toxicity Cancer

To Avoid Harmful Fats of All Kinds, Ditch Processed Foods

If you want to avoid dangerous fats of all kinds, your best bet is to eliminate processed foods from your diet. From there, use these tips to make sure you’re eating the right fats for your health:

  • Use organic butter (preferably made from raw milk) instead of margarines and vegetable oil spreads. Butter is a healthy whole food that has received an unwarranted bad rap.
  • Use coconut oil for cooking. It is far superior to any other cooking oil and is loaded with health benefits.
  • Be sure to eat raw fats, such as those from avocados, raw dairy products, olive oil, olives, organic pastured eggs, and raw nuts, especially macadamia nuts which are relatively low in protein. Also take a high-quality source of animal-based omega-3 fat, such as krill oil.

Following my comprehensive nutrition plan will automatically reduce

your trans-fat intake, as it will give you a guide to focus on healthy whole foods instead of processed junk food. Remember, virtually all processed foods will contain either HFCS (probably made from genetically engineered corn) and/or soybean oil — either in the form of partially hydrogenated soybean oil, which is likely made from GE soybeans, loaded with glyphosate, or from one of the newer soybean varieties that were created such that they do not need to be hydrogenated. They’re ALL bad news, if you value your health.

Source: mercola.comsoybean-oil

No Relation Between Length of Treatment for UTIs and Early Recurrence in Men.


How long to continue antibiotics in men with urinary tract infections is still up for debate.

 

Most research to examine length of antibiotic treatment for uncomplicated urinary tract infections (UTIs) has been conducted in women, for whom clinical guidelines are well established. In a retrospective study of 33,336 veterans with uncomplicated UTIs (all outpatients; mean age, 68; median antibiotic-therapy duration, 10 days), researchers explored whether length of antibiotic therapy was associated with recurrence in men. Most patients received ciprofloxacin or trimethoprim-sulfamethoxazole; about one third were treated for 7 days, and the rest were treated for >7 days.

Researchers found 1373 cases of early recurrence (at 30 days; 4% of the cohort) and 3313 cases of late recurrence (at >30 days; 10%). In multivariate analyses, no difference was noted in risk for early recurrence between men who received longer- or shorter-duration initial treatment; risk for late recurrence was significantly higher among those who received longer-duration treatment than among those who received shorter initial courses (11% vs. 8%).

Comment: This retrospective study involved an administrative database that could not capture fully the many factors that influence clinical decision making and that also might be associated with recurrence (i.e., catheter use). However, this study does suggest that the same clinical trials that were conducted in women would be justified in men to develop more precise guidelines on length of treatment.

 

Source: Journal Watch General Medicine

 

 

Preventing Death from Septic Shock in Patients with Cirrhosis.


Getting the initial antimicrobial therapy right seems critical to saving these patients.

 

Septic shock is a major cause of admission to intensive care units among patients with cirrhosis, which results in significant morbidity, mortality, and cost. Early administration of appropriate antimicrobials and combination regimens are suggested as practice-related factors that might improve survival in this group. To investigate this issue, researchers identified 635 adult patients with septic shock and cirrhosis in a database from 28 medical centers in the U.S., Canada, and Saudi Arabia and examined relationships between factors related to delivery of antimicrobial therapy and hospital mortality.

The mean age of the cohort was 56 years, and the mean model for end-stage liver disease score was 26.7. Hospital mortality was 75.6%. Inappropriate initial antimicrobial therapy was administered in 24.4% of patients and was associated with increased risk for mortality (adjusted odds ratio, 9.5; 95% confidence interval, 4.3–20.7). A delay in administration of appropriate antimicrobial therapy was also associated with an increased risk for mortality (adjusted OR for each hour of delay, 1.1; 95% CI, 1.1–1.2). Finally, 72.9% of patients with bacterial septic shock received only a single antibiotic agent, which was associated with an increased risk for mortality compared with receipt of 2 agents (adjusted OR, 1.8; 95% CI 1.0–3.3).

Comment: These study findings underscore the high hospital mortality rate among patients with cirrhosis and septic shock. More importantly, they identify modifiable practice-related factors that could reduce that mortality rate. Therefore, early identification and aggressive management with broad-spectrum antimicrobial agents should lead to improved hospital survival in this population.

 

Source: Journal Watch Gastroenterology

 

McGrath Series 5 Video Laryngoscope Outperforms Macintosh.


In healthy adult patients with manual cervical spine immobilization, glottic views were better and intubations more successful.

 

Researchers randomized 88 healthy adults undergoing elective surgery at an academic center in Canada to intubation with a Macintosh laryngoscope or McGrath Series 5 video laryngoscope. Attending anesthesiologists who practiced with the McGrath Series 5 on a manikin until comfortable with its use evaluated glottic visualization using both devices, and intubated the trachea using the second device. Manual cervical spine immobilization was applied to simulate difficult intubation. Laryngeal manipulation maneuvers were not permitted. Patients with reactive airway disease, gastroesophageal reflux, ischemic heart disease, recent stroke or myocardial infarction, or cervical spine instability were excluded.

Baseline characteristics were similar between groups. All McGrath intubations were successful compared with 59% of Macintosh intubations. Intubation failures were due to inability to view the glottis. The McGrath group had significantly more Cormack-Lehane grade I or II glottic views (100% vs. 51%) and higher mean percentage of glottic opening (82% vs. 13%). The McGrath video laryngoscope improved the glottic view, compared with the Macintosh, in 66 patients (75%): by one grade in 36%, by two grades in 53%, and by three grades in 11%. Mean intubation time was longer with the McGrath (36 vs. 22 seconds). Rates of complications, all minor, were similar in the two groups.

Comment: The McGrath Series 5 video laryngoscope had a higher intubation success rate and improved glottic visualization in patients with cervical spine immobilization, compared with the Macintosh laryngoscope. The McGrath’s longer intubation time is not clinically significant, and if the study design had allowed for laryngeal manipulation, Macintosh intubations would likely have been more successful but also taken more time. With so many studies showing superiority of video laryngoscopes over direct laryngoscopes, perhaps it is time to halt these types of comparisons and move on to comparisons of one video laryngoscope with another.

 

Source: Journal Watch Emergency Medicine