Statins added to WHO list of “essential” drugs

June 8th, 2007

Well, it finally happened. The statin peddlers convinced WHO to add statins to the list of essential drugs.

But look at who was behind the initiative, Dr Gotto

Dr. Gotto receives many thousands of dollars from statin peddlers.

Here is a disclosure statement from a recent publication

“Antonio M. Gotto, Jr., MD, DPhil, serves as a consultant for
AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson-Merck, Kos
Pharmaceuticals, Kowa, Merck & Co., Inc., Merck-Schering Plough,
Novartis, Pfizer Inc, and Reliant Pharmaceuticals.”

Surely this should have been mentioned in the Cornell press release.

Personally, I refuse to take any advice from anyone who receives even one cent from a drug dealer.

I completely agree with Dr Kishore’s statement:

“Increasingly, ‘Western’ high-fat diets, tobacco use and urbanization have
helped make heart disease a bigger killer than ‘The Big Three’—HIV/AIDS,
tuberculosis and malaria—combined.”

Indeed, high risk individuals have high risk lifestyles.

But the FIRST thing to do is change the diet and eliminate tobacco BEFORE labeling statins essential drugs. To do otherwise will reduce any incentive to improve lifestyle and make the obesity and diabetes pandemic even worse.

Do you think that the “developing” world is going to be happy with generic simvastatin? Not likely. They are going to start demanding patented Crestor and Vytorin, just like the rich Americans.

Cubans take no statins but live longer than Americans? If statins are not essential in Cuba, why should they be in Africa?
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Weill Cornell Medical College Students Help Change Global Health Policy

NEW YORK (May 21, 2007) – In a move to improve global public health, Weill
Cornell Medical College students have helped place a lifesaving heart
disease drug onto the World Health Organization’s (WHO) list of essential
medicines. This list is a guideline for developing countries to choose which
high-priority drugs should be supplied to their citizens inexpensively.

Students from Weill Cornell’s chapter of Universities Allied for Essential
Medicines (UAEM) answered the charge of Dr. David Skorton, President of
Cornell University, and Dr. Antonio M. Gotto Jr., dean of Weill Cornell
Medical College, to “seek new strategies for Cornell to advance public
health” across the globe.

“I am extremely proud that the students at Weill Cornell Medical College
have had such an admirable influence on global health policy,” says Dr.
Skorton, who is also a professor of internal medicine and pediatrics. “Such
actions by our students show the promise of their future leadership.”

“Adding this medicine to the list of essential medicines represents an
exceptional achievement by our students,” says Dr. Gotto, an internationally
renowned expert in heart disease prevention, who served as the senior
advisor for the project. “Because of the students’ success, over 150
national governments that work with WHO will be encouraged to recognize
heart disease as a serious health concern deserving of great medical
attention.”

UAEM comprises a national group of students whose goal is to determine how
universities can help ensure that biomedical products, including medicines,
are made more accessible in poor countries and further the amount of
research conducted on neglected diseases affecting the poor.

“For years, it was thought that heart disease was a concern of affluent
countries. But, today, nearly 80 percent of all deaths due to heart disease
occur in the developing world,” says Sandeep Kishore, an MD-PhD student at
Weill Cornell Medical College who helped spearhead the initiative with UAEM.
“Increasingly, ‘Western’ high-fat diets, tobacco use and urbanization have
helped make heart disease a bigger killer than ‘The Big Three’—HIV/AIDS,
tuberculosis and malaria—combined.”

Kishore and Ben Herbstman, UAEM members, petitioned WHO that simvastatin
(Zocor)—originally manufactured by Merck—be added to the list. Simvastatin
was selected based on its worldwide availability, cost-effectiveness and the
interest of generic firms in producing it. Such statin medicines have been
shown to lower low-density lipoprotein cholesterol (LDL) levels, commonly
known as “bad cholesterol,” by 25-30 percent in individuals at high-risk for
heart disease.

Last month, the students from UAEM — with the assistance of medical
librarians from Weill Cornell’s Samuel J. Wood Library & C.V. Starr
Biomedical Information Center — were successful in their efforts to get a
generic version of Zocor included on the list of essential medicines. Now,
the United Nations and other philanthropic foundations can donate large
numbers of the statin drug to the national pharmaceutical inventories of
developing countries.

Furthermore, generic versions of the medicine will be sold at a fraction of
their original price tag. The drug will cost as little as $40 per year per
person—10 cents a day—down from nearly $1,200 a couple of years ago.

The announcement comes on the heels of Cornell University’s new Africa
Initiative, a university-wide movement to promote sub-Saharan African
development and health.
The Weill Cornell chapter of UAEM has hosted an ongoing series of global
health events. On June 15, the former CEO of Merck, Inc., Dr. Roy Vagelos,
will present a lecture titled “Corporations Can and Should Do Social Good”
in a seminar exploring new academic-pharmaceutical alliances to increase
access to medicines worldwide.
Weill Cornell Medical College

Weill Cornell Medical College—located in New York City—is committed to
excellence in research, teaching, patient care and the advancement of the
art and science of medicine. Weill Cornell, which is a principal academic
affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum
that integrates the teaching of basic and clinical sciences, problem-based
learning, office-based preceptorships, and primary care and doctoring
courses. Physicians and scientists of Weill Cornell Medical College are
engaged in cutting-edge research in such areas as stem cells, genetics and
gene therapy, geriatrics, neuroscience, structural biology, cardiovascular
medicine, AIDS, obesity, cancer and psychiatry—and continue to delve ever
deeper into the molecular basis of disease in an effort to unlock the
mysteries behind the human body and the malfunctions that result in serious
medical disorders. Weill Cornell Medical College is the birthplace of many
medical advances—from the development of the Pap test for cervical cancer to
the synthesis of penicillin, the first successful embryo-biopsy pregnancy
and birth in the U.S., and most recently, the world’s first clinical trial
for gene therapy for Parkinson’s disease. Weill Cornell’s Physician
Organization includes 650 clinical faculty, who provide the highest quality
of care to their patients. For more information, visit www.med.cornell.edu.

Contact:
Andrew Klein
(212) 821-0560
ank2017@med.cornell.edu

Sandeep Kishore
(917) 733-1973
sunny.kishore@gmail.com

# # #


Sandeep P. Kishore, M.Sc.
Medical Scientist Training Program (MSTP) Fellow
Weill Cornell / The Rockefeller University / Sloan-Kettering Cancer
Institute
Tri-Institutional MD-PhD Program
420 East 70th St, Suite 10M
New York, New York, USA 10021
email: sunny.kishore@gmail.com
tel: (917) 733 -1973
_______________________________

The farm vote is more important than health and the environment

May 4th, 2007

While this is not a medical myth, you will not find a doctor complaining about the huge subsidies direct or indirect awarded to dairy farmers, particularly in Canada. In spite of all the breast-beating from politicians about the need to stem the obesity pandemic and clean up the environment, when it comes to keeping the farm vote obesity and the “environment” disappear from the radar screen.

Whey is about as ideal a food as can be found except for the lactose intolerant. Very nutrient dense, low fat and cheap. But dairy farmers need to sell butter fat because they are paid by the total amount of solids in the milk and fat is a large component of milk solids. Due to the apportionment of ridings, a rural vote is worth twice an urban vote. Also, the majority of Canadian dairy farmers are in Quebec and the minority Conservative government is desperate to increase its members from this crucial Province.

The sole goal of a democratic government is to get re-elected. So, politicians will do anything to keep the farm vote, including ignoring threats to the survival of our species, let alone a lot of other species.

Here are two reports on this exercise in raw politics from both of Canada’s national newpapers.

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Government’s cheese plan stinks

 

 

New laws would favour dairy industry over good health

 

National Post

nutrition@nationalpost.com

 

Recent initiatives by Health Canada might have you believing that the Canadian government is looking out for our health. But appearances can be deceiving. While Ottawa is offering up recommendations along with resources on healthy eating, they’re also readying to slash the availability of some of our more nutritious and tasty food choices, namely lower-fat cheeses.

The Canadian Food Inspection Agency (CFIA) has been trying, very quietly, to bring in legislation that would change the rules of how cheese sold in this country can be made. And it’s a push that could significantly undermine our ability to implement the government’s own healthy eating recommendations.

The availability of lower-fat cheeses makes meeting the required number of servings from the milk and alternatives group an easier task. Besides offering protection against high blood pressure and osteoporosis, their lesser quantities of saturated fat also impact the risk of heart disease and diabetes. Saturated fat is not just a culprit in boosting blood cholesterol readings but has also been linked to a decrease in insulin sensitivity — the first step towards developing type 2 diabetes.

Currently in the making of lower-fat cheeses, processors can decrease the fat content in their products but, to make their cheeses more palatable, add milk components like milk solids and whey. The added protein from the whey affects the mouthfeel of cheeses, making them taste like higher-fat products.

But if the CFIA has its way, many of the lower-fat cheeses now available would be illegal because of the added whey.

Using whey makes cheesemaking more economicaland leads to better prices for consumers. Incorporating it to make lower-fat cheese also lessens the impact of any waste products from cheesemaking on the environment. At the same time, most people would not be interested in eating lower-fat cheese. Anyone who remembers the taste and texture of the first versions of low-fat cheese understands this.

So why is the CFIA proposing these new regulations? While the agency’s mandate is to “protect Canadians from preventable health risks,” the CFIA is not under the jurisdiction of Health Canada. The agency, in fact, reports to the Minister of Agriculture, and the minister may be making dairy farmers very happy with these proposals. The CFIA is proposing a maximum ratio of two proteins found in milk — whey and casein. Limiting whey would force cheese makers to use more fluid milk — and therefore more money for dairy farmers.

But it would potentially be at the expense of the health of Canadians.

Health Canada has started to take a more active stand on a variety of nutrition issues as of late and, through its new food guide, recommends we look for “reduced fat or lower fat cheeses. Lower fat cheeses generally have less than 20% milk fat (M.F.).”

When told that there could be a problem with the availability of lower-fat cheeses, Health Minister Tony Clement stated, “I’d be concerned about that.”

It appears, though, that on this issue Health Canada has been asleep at the wheel. Renée Bergeron, a Health Canada spokesperson stated, “Based on our initial review, Health Canada considers that the proposed changes to cheese standards would not be expected to compromise the nutritional quality of cheeses and cheese products. However, we will continue to work with CFIA on this file as comments are received as part of the consultation for the regulatory process.”

Initial review? These proposals were announced in February. And it seems that the CFIA didn’t notify or invite comments from wellknown health advocacy groups that might have had some interest in the proposed legislation. When members of the Dietitians of Canada asked their association to respond to the CFIA about their concerns, the organization was denied an extension to provide their comments.

The cheesemaking industry is also up in arms. The Dairy Processors Association of Canada (DPAC/ATLC), Canada’s nationalassociation representing the public policy and regulatory interests of the Canadian dairy processing industry, has asked for an immediate halt to the process. In a news release in May, the association stated that these new regulations on cheese could result in $1.5-billion impact on Canadian consumers, trade and the economy. Prices for all cheeses would increase substantially. And many imported cheeses would not meet the new criteria.

Health Canada’s Bergeron also stated: “For information about work being done by industry on the development of innovative low-fat cheeses, Health Canada suggests that you contact Agriculture and Agri-Food Canada or the CFIA.”

But has anyone asked the industry about its advancements in the production of low-fat cheeses? According to Don Jarvis, president and CEO of the Dairy Processors Association of Canada, there have been a number of innovations that the cheese industry has developed over the past decade to produce healthier options — it’s these new techniques that the CFIA is attempting to stamp out.

We’re finally making headway in combining taste and good nutrition, so why does the government want us to take a step backwards?

Rosie Schwartz is a Toronto based consulting dietitian in private practice and is author of The Enlightened Eater’s Whole Foods Guide: Harvest the Power of Phyto Foods (Viking Canada).

 

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Mr. Strahl, it’s not the Canadian whey

 

OTTAWA — Like Little Miss Muffet, Canadians have been consuming their curds and whey - and helping the environment at the same time. By choosing “light” cheeses at the supermarket, products that recycle whey, Canadians have exponentially increased the country’s consumption of a waste product traditionally bereft of commercial uses. Since residual whey is a significant industrial pollutant, this marketplace adaptation has produced a fine symbiotic relationship. Fewer calories for people. Less wastes for industry.

In this allegorical construct, the next character we encounter should be the Spider. Enter Agriculture Minister Chuck Strahl as Spiderman. When Mr. Strahl addressed a convention of dairy farmers in February, he announced that he had directed federal food regulators “to launch a regulatory process related to the compositional standards for cheese.” He had taken this action, he said, “to protect consumer interests and to promote choice in the marketplace.”

The federal guardian of supply-management farming had come to help Canadian consumers? This was more ominous than it sounded. Run, Miss Muffet. Run.

As subsequently translated, Mr. Stahl’s announcement meant that the government proposed to compel Canadian food processors to use more “full-fat” milk to make “light” cheese, prohibiting the use of recycled whey in some instances, restricting it in others. As you might suspect, however, the actual work was already well advanced. The regulations will require, for example, that mozzarella contain 63 per cent full-fat milk, that cheddar cheese contain 83 per cent full-fat milk, that “fine cheeses” contain 98 per cent full-fat milk.

In many cases, these requirements will prevent the recycling of whey from byproduct into buy-product. Even as Health Canada advises Canadians to consume more “light,” low-fat foods, Agriculture Canada will make it more difficult to do so.

We’re talking huge quantities of whey. Every pound of cheese produces nine pounds of whey - and Canadian cheese makers last year produced 350,000 tons of cheese. The Dairy Processors Association of Canada, representing companies that turn raw milk into products worth more than $10-billion a year, says Mr. Strahl’s restrictions will put 300 million litres of whey back into the environment for disposal. “Environmental regulations,” the association says, “make this disposition almost impossible and very costly.”

Whey is the liquid that remains after the removal of fat from whole milk. It’s rich in minerals and carbohydrates. Farmers used to feed it to pigs. Rural cheese factories used to dump it into rivers and streams. In the past few years, technology has produced a few commercial uses, notably in processed cheeses where it keeps cheese moist. It can be dried into a powder and used to bind fat and water in canned meats and sausages. It can be converted into alcohol - where it has found its way into Baileys Irish Cream. Theoretically, it can be made into ethanol.

The environmental problem is that whey has extremely high BOD, or biological oxygen demand. BOD measures the biologically degradable substances in sewage.

These substances are broken down by micro-organisms that consume oxygen. You can’t dump whey into a river or a lake because these micro-organisms will consume the oxygen and kill the waterway. You can’t dump it into conventional sewage systems because these micro-organisms cling together and clog the pipes. This has been known for ages. One old text advised farmers: “It is a cardinal rule that no milk product ever be dumped into a stream or a sewage system.”

Whey’s BOD can be expressed as 40,000 parts per million. By comparison, the BOD of cream (with 40 per cent butterfat) is 400,000 parts per million; the BOD of skim milk is 70,000 parts per million. The BOD of human waste is 200 parts per million. Try as you can, you can’t avoid a final unpleasant comparison.

BOD comprises 3.5 per cent of whey. Multiply 300 million litres a year of surplus whey by 3.5 per cent. You get 10.5 million litres of BOD - precisely equal to the human waste of 4.5 million Canadians. Run, Miss Muffet. Run.

The Dairy Producers Association of Canada says 30 per cent of the cheese currently imported into the country (value: $100-million) will not comply with the impending rules. Cheddar cheese from the village of Cheddar in Britain’s Somerset County won’t meet the federal government’s butterfat-based definition of “cheddar.” It says the high cost of milk will force food processors to substitute vegetable oils for butterfat - further hurting the dairy farmers Mr. Strahl wants to help.

The moral of this fable? Don’t trust Chuck Strahl with your cheese. You’ll pay more for your curds. You’ll lose your whey - and your tuffet, too.

nreynolds@xplornet.com

Get With The Guidelines - Do as the drug salesmen say

May 4th, 2007

Here is a classic example of drug dealers influencing the prescribing habits of doctors. If you read this GWTG-CAD carefully you will find a litany of insinuations WITHOUT PROOF. The data presented here are only observational. There is no control group. What were the lipids of the population that didn’t have a heart attack? The main insinuation is that the only cause of atherosclerosis is “dyslipidemia” and if the whole population of the world achieved “ideal” lipid levels by taking enough statins to lower their LDL to less than 70 mg/DL and somehow managed to also get their HDL higher than 60 mg/DL, there would be no heart attacks. There is NO PROOF for this hypothesis. 21% of the heart attack patients were on statins before their heart attack but still had one!

aha-gwtg-cad.jpg

Now, if you want to know how such stupidity gets into print and gets the backing of the AHA, just look at the disclosures which are in small print at the bottom left. Enough said.

aha-gwtg-cad-disclosure.jpg

ILLUSTRATE illustrates the futility of measuring and treating blood “cholesterol”

March 31st, 2007

Intravascular ultrasound is a sensitive method for measuring the size of atherosclerotic plaques in the arterial wall. When testing a drug to see if it will have an effect on plaque volume, this technique is the gold standard.

ILLUSTRATE set out to show that adding torcetrapib, a drug that increases HDL, the “good” cholesterol, to Lipitor, that decreases, LDL, “bad” cholesterol would reverse plaque or at least stop its progression.

nejm-illustrate-abs.jpg

Here are the baseline characteristics of the subjects. Note that the AVERAGE BMI was 30. Obesity is defined as a BMI over 30. So, most of them were overweight or obese. 20% were diabetic, most likely Type 2, related to obesity, and 75% were hypertensive. 18% smoked. ALL of those factors are risk factors for atherosclerosis related to lifestyle. Therefore, unless one intends to first completely eliminate these lifestyle risk factors, it was UNETHICAL to even conceive such a trial . One can rationalize that if atherosclerosis is only treatable by drugs and Pfizer, who funded the trial, has a slogan, “Working for a Healthier World” it is ethical to do such a trial. Besides the money helps to keep one’s IVUS lab going and one is promoting the notion that the technique will some day lead to the cure for atherosclerosis.

nejm-illustrate-base.jpg

Here are the reported results. What was not mentioned in the abstract above is that plaque actually INCREASED in both the the Lipitor only group and the Lipitor plus torcetrapib group. Now, before actually starting the trial, the subjects were given enough Lipitor to adhere to the guidelines written by doctors paid by Pfizer and other statin dealers. So, following the guidelines for blood cholesterol lowering with Lipitor does not slow progression of plaque. The obsession with blood cholesterol is completely FUTILE.

nejm-illustrate-result.jpg

The conclusions of the authors shows their blinkered view of atherosclerosis. We have known how to reverse the atherosclerotic process very easily since the revolutionary work of Dean Ornish published 16 years ago. NO DRUGS are necessary, only a change in lifestyle which was not seriously attempted in this study. So, why don’t the IVUS groups do a study of plaque volume after significant lifestyle change? Who would fund it? If Pfizer is really “Working for a Healthier World” and not just making a profit, Pfizer should be funding a lifestyle trial.

nejm-illustrate-conclu.jpg

Child obesity and trans fat, a politically correct scapegoat

March 28th, 2007

Here is a classic example of politicians trying to deflect responsibility for a problem away from the average voter, whom they are loath to antagonize, to a politically powerless scapegoat. You will never hear a politician say that eating TOO MANY CALORIES because of food addiction is the cause of pandemic obesity. That would upset the whole food supply industry and rural voters whose votes are worth twice a much as city dwellers. So, politicians blame trans fat and recommend building more gyms, changes that will make ABSOLUTELY NO difference but will not injure an delicate voter sensibilities.

 

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Child obesity an epidemic, Ottawa told

 

25% OVERWEIGHT: COMMONS COMMITTEE For first time, Canada’s younger generations are expected to live shorter lives than parents

OTTAWA – More Canadian children are overweight and for the first time the country’s younger generations are expected to live shorter lives than their parents because of obesity, says a new Commons committee report made public yesterday.

Committee MPs said they were “shocked” to learn about the increase in overweight children, from 12 per cent to 18 per cent, and obese children, from three per cent to eight per cent, between 1978 and 2004.

That makes about one in four Canadian children overweight or obese.

The report said parents must be in denial, as a Canadian Medical Association survey found only nine per cent report they have a child who is at least somewhat overweight.

The health committee called yesterday for aggressive measures to halt child obesity, and said they share fears of experts that “today’s children will be the first generation for some time to have poorer health outcomes and a shorter life expectancy than their parents.”

Highlights of recommendations are a ban on trans fats as advised by a federal task force; use of a mandatory, simplified, standardized food labelling system; and designation of federal funds to build or replace aging playgrounds, sidewalks, rinks, pools and other community exercise spots across the country.

The report said most Canadian children spend too much time in front of TV and computer screens; don’t get the expert-recommended 90 minutes a day of exercise; eat too much fat and junk food; consume too many sugary drinks and don’t eat the recommended five daily servings of fruit and vegetables.

The committee also reported the “distressing” and “most alarming” number of 55 per cent of First Nations children living on reserves, and 41 per cent off reserves, are overweight or obese.

There is so much poverty among First Nation and Inuit people that many people cannot afford nutritious food, especially in remote northern communities, the report said.

And of more than 500 First Nations schools, only half have a gym.

The health committee proposed Canadians take up a national challenge to halt a 30-year rise in overweight children in just three years – by the 2010 Olympic games in Vancouver. Then targets to reverse the trend could kick in.

“It is ambitious but it is doable,” committee chairperson Rob Merrifield, an Alberta Conservative MP, told a news conference.

“For the first time in recorded history, our younger generations are expected to live shorter lives than their parents due to obesity,” he said in a prepared statement.

“New and aggressive action is required to address this complex and, ultimately, very costly problem.”

The report was welcomed by the Heart and Stroke Foundation, which has long warned “fat is the new tobacco,” and by the Canadian Medical Association.

Foundation chief Sally Brown said overweight children are on “a fast track” to developing hypertension, heart disease and stroke.

New Democratic Party MP Penny Priddy said by chronicling links between poverty, poor diet and lack of exercise, the report busts a myth that overweight children all sit around playing on computers and watching TV. She cited the example of children in poor families being fed Kraft Dinner instead of going to bed hungry.

Kraft Dinner is a brand of macaroni and cheese, an inexpensive food.

Expressing concern that the committee would get into trouble with the Kraft corporation, Merrifield said “I love Kraft Dinner.”

The report said on average, adolescents in Canada spend almost 35 hours a week in front of a TV or computer screen – more time than in the classroom over the course of a year. Studies had shown the less time in front of a screen and the more activity, the less weight.

The committee also postponed a decision on a possible ban on food advertising to children, saying it would assess the impact of self-regulation in Quebec, Sweden and other jurisdictions in a year before deciding on the issue.

Bloc Québécois MPs issued a dissenting report, saying the Quebec government already has a well-defined strategy to deal with juvenile obesity and that the federal government should stick to its own jurisdiction in health, which is confined to First Nations and Inuit people.

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According to studies conducted at the University of Guelph, Canadians consume an average of eight to 10 grams of trans fats per day. At 9 kcal/gm for fat, trans fat account for at most 90 kcal/day. This is the cause of the obestiy pandemic? One pound of fat is about 3500 kcal, so it would take about 40 days to gain or lose one pound of fat if one adds the trans fat or eliminates it respectively. But that trans fat is always REPLACED with another form of fat with the same calories. A gram of trans fat has the same caloric value as a gram of oil or other fat. So one has to reduce the TOTAL FAT and TOTAL CALORIE intake to make any difference.

Here is what is often used to replace trans fat. No cholesterol, no trans fat, omega-3. These slogans are now used by food manufacturers to market even more junk calories. I predict the pandemic will only worsen. Nobody wants to deal with the fundamental problem, food addiction. See my photo essay on food addiction.