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Watchman trial: right device, wrong patient population.

April 3, 2009

Analysis of:ACC: Device May Prevent Stroke in AF Patients | www.medpagetoday.com

1. Left atrial appendage is not the only source of systemic thromboemboli. Thrombi form in the rest of the left atrium and even in the ventricle. 2. The trial did not address issues of thrombogenicity of the device by itself. 3. "Pericardial effusion" was not an effusion, but a bleeding from the appendage after device was deployed. 4. The trial did not include population with contraindications to anticoagulation: instead comparing embolic stroke rates in patient with atrial fibrillation with contraindications to Coumadin with and without Watchman, the trial involved anticoagulated patients with and without the device and analyzed the rates of hemorrhagic stroke!!

EMR: burden for clinicians.

April 3, 2009

Analysis of:U.S. Hospitals Slow to Adopt E-Records | online.wsj.com

While the majority of hospitals have some degree of EMR, none have truly "fully functional" EMR. EMR: 1. Do not increase profit, do not increase productivity, do not save time, do not increase quality of care; 2. Do increase potential for litigations, do increase degree of control of clinicians by administration and insurance carriers, can remarkably decrease quality of care.

Darusentan and Resistant Hypertension

April 2, 2009

Analysis of:Phase III Study of Gilead's Darusentan for Resistant Hypertension Meets Primary Endpoints | investors.gilead.com

The most recent press release from Gilead Scienes, Inc. (Nasdaq: GILD) re: phase III study of Darusentan, a novel endothelin receptor antagonist, designed to control resistant hypertension. The effectiveness in controlling systemic blood pressure was found to be statistically significant. Incidence of anemia and liver toxicity did not seem to be significant. Frequency of peripheral edema was remarkable.

Multivitamins, filtered water, shark cartilage, black magic etc.

March 10, 2009

Analysis of:Multivitamins: Fact or Fiction | www.usatoday.com

Treatment modalities given for symptoms rather than for treatment of correctly diagnosed diseases by definition must have no effect since the same symptoms (headache) might be produced by different and often opposite conditions (low vs. high blood pressure). The same applies to prevention of conditions unprofessionally grouped into artificial categories, such as "heart disease" or "cancer". They have different and often not entirely understood etiologies. Substances, therefore, advertised as universally preventive modalities must be completely ineffective in order not to potentiate the effect of the true cause of the disease.

Important Revelation with no Sequences.

December 10, 2008

Analysis of:Generic Heart Drugs as Good as Brand-Name Counterparts | www.washingtonpost.com

No doubt generic and brand-name drugs are the same or almost the same not only in cardiovascular medicine, but in majority of other applications as well. It is not a surprise: companies are not going to study generic drugs in search of new benefits. There are some advantages, however, of brand-name drugs, such as extended release formulation, or immediate release package or absence of certain side effects, for example.

Healthcare reform will save American economy: a new, very advanced, form of delusion.

December 8, 2008

Analysis of:Medicine for the Job Market | www.nytimes.com

The entire article is based on unfound assumptions. My favorite sequence is the following. Primary healthcare is provided by non-physicians, mostly RNs, PAs etc?! By focusing on primary care, government will create a job market for people who lost their jobs in other industries?! Example: laid off workers from Ford's assembly lines will go to the nursing schools and years later oversaturate healthcare institutions already effectively wasting tax payers' money.

J&J acquired Mentor specializing on "luxury" surgery during economic recession.

December 8, 2008

Analysis of:Johnson & Johnson buys medical device maker | www.nytimes.com

Mentor Corporation is commited to plastic, mostly aesthetic surgery products, the ones affected more than any other medical fields by recession: medical insurances do not cover majority of plastic and all of aesthetic procedures, they have to be paid in cash.

Feasibility of Group Appointments

December 5, 2008

Analysis of:The doctor will see all of you now | www.boston.com

The group appointments concept is not new. For example, there is  "gall bladder work shop" in one of big healthcare system. After patients have diagnosis established, they come as a a group to have a physician explain to them what the diagnosis is and what needs to be done and answers individual questions.

Heart Assisting Devices: more is not always better.

December 2, 2008

Analysis of:Researchers Find Poor Use of Pumps for Ailing Hearts | www.nytimes.com

VAD (ventricular-assisting devices) are definitely loosing popularity. The one of main reasons for that is extremely poor reimbursement. It is hard to make conclusions from the cited study. It is performed by Medicare. The average age of patients in the study was 63 years. Age over 65 is one of contraindications for the heart transplant. The most common indication for VAD placement in the study was "bailing out" futile cases. That decreased mortality, but simultaneously increased morbidity and, therefore, cost.

Plavix and Nexium: incomplete data wrongly interpreted.

November 19, 2008

Analysis of:Plavix Study Faults Mixing Pills | online.wsj.com

Heartburn and heart attack are two types of discomfort in the chest. Patients with coronary artery disease AND gastro-esophageal reflux disease often take PPI for chest pain and, therefore, tend to seek medical attention in more advanced stages of coronary artery disease.

Stent Oligopoly: bigger stakes, bigger trials.

October 20, 2008

Analysis of:Health Firms to Study Clots in Stent Patients | online.wsj.com

This collaboration will be very successful: the trial involving 20 000 patients will take a long time to complete. During the trial utilization of stents will not change. Upon completion of the trial it will become even more obvious that 2 years of "blood thinning" is better than 1 year for stents potency rates. The complications of prolonged "blood thinning", however, will promote search for a safer "blood thinner".

Amiodarone is here to stay.

October 20, 2008

Analysis of:Wyeth Heart Drug Not A Short-Term Option | www.pharmalot.com

Amiodarone is still one of the best drugs for atrial fibrillation despite "rare incidence" of cirrhosis, lung fibrosis and now "rare muscle injury".

Medtronic: chasing the tail.

October 20, 2008

Analysis of:Medtronic Endeavor Heart Stent Tied to Complications | www.bloomberg.com

Utilization of a device in a setting of marginal data is not driven by that data, but by the reimbursement rates. Medtronc might loose the battle, but stents are still winning the war.

End of Era: Abbott's Attempt.

October 14, 2008

Analysis of:Abbott: Clinical trial shows stent 'does its job' | www.forbes.com

Currently, bioabsorbable stents do not provide better solution than traditional stents for the major problems of early thrombosis and absence of long term advantage compared with medical management (in appropriate patients).

Great Relieve: not Stroke, only Death and Heart Attack.

October 14, 2008

Analysis of:Data show no stroke risk with Pfizer lung drug: FDA | www.reuters.com

The risks of death and myocardial ischemia have not been disproved. The data of stroke possibility was not finalized by FDA.

Misleading Headline

October 13, 2008

Analysis of:C. Difficile And Antibiotics Not Necessarily Linked, Study Finds | www.sciencedaily.com

The headline is misleading. C. Dif. diarrhea is well established consequence of antibiotics induced imbalance in the colon. The cited study did not disprove that. What the study actually showed that C. Dif. diarrhea can be also induced by other, unknown so far, factors as well as by antibiotics.

Disease-risk Data: will be read, but will not be implemented.

October 13, 2008

Analysis of:Study to Track How People React to Disease-Risk Data | online.wsj.com

The data obtained from genetic analysis will be more of inherited predisposition to certain conditions type rather than cause-sequence relationship type. Therefore, it can be compared to other analyzes of risk factors such as credit score or car insurance assessment. It will be, therefore, read, appreciated and interpreted by people in similar way. Another extrapolation is how currently available facts of family history affect people behavior, for example coronary artery disease of premature onset in relatives of first degree.

Risky of Safe: can be both depending on patient selection (just like all other drugs).

October 6, 2008

Analysis of:COPD Medicines: Risky or Safe? | www.webmd.com

Of course anticholinergic drugs leave sympathetic stimulation unbalanced. They, therefore, may act in certain individuals as weak sympathomimetic producing arrhythmias, hypertension, tachycardia, vasoconstriction etc. with know sequences, such as atherosclerosis, cerebrovascular and coronary effects. They should be avoided in individuals with well established risk factors.

Killer gas from basement is a cause of lung cancer.

October 6, 2008

Analysis of:Protecting a Home From Silent Threat | www.nytimes.com

How somebody can possibly come up with mentioned estimation: "...20,000 people die from radon-induced lung cancer every year..."? Where is the denominator: how many non-smokers with documented constant radon exposure acquire lung malignancy?

"Fatty liver", "deadly quarter" etc.: update on German research.

September 22, 2008

Analysis of:Researchers Find Cause Of Severe Metabolic Disorders | www.medicalnewstoday.com

Mentioned myocardial infarction and stroke are sequences of arterial atherosclerosis with established risk factors being: hypertension, tobacco abuse, diabetes, dyslipidemia, obesity, sedentary life style and presence of clinically significant atherosclerosis in relatives of first degree. There is no "fatty liver" factor, neither there is "deadly quartet". There is also no data indicating that decreased cortisol production protects from atherosclerosis. There is, however, data that insufficient cortisol might reduce weight among many other serious metabolic disturbances.

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