GLG News by Physicians who Treat Peripheral Vascular Disease

Dan StrejaClinical Professor of MedicineUNIVERSITY OF CALIFORNIA, LOS ANGELES

Actos has little to worry about Avandia lawsuits

May 10, 2011

Analysis of:Glaxo May Settle 1,000 More Lawsuits Over Avandia, Patients’ Lawyer Says | www.bloomberg.com

The FDA has practically eliminated Avandia based on either an analysis considered by everybody faulty or on data that were never released to the public. Actos has a different cardiovascular safety profile and Takeda should not and probably will not settle any lawsuits concerning risk of heart attack.

Dan StrejaClinical Professor of MedicineUNIVERSITY OF CALIFORNIA, LOS ANGELES

Aspirin cuts heart attack but not strokes, but not in everybody

April 24, 2011

Analysis of:Aspirin cuts heart attacks, but not deaths or strokes: study | www.reuters.com

Aspirin is a great drug to take for prevention of heart attacks but is not for everybody: - In women aspirin prevents strokes but not heart attacks - In patients with diabetes and no heart disease it does not seem to work - In patients with poor circulation to the legs it is not strong enoughThe lack of prevention of death might be due to the fact that the patient studied had less heart attacks but did not oblige the investigators by dying for them. Given the right patient aspirin remains a great drug.

Dan StrejaClinical Professor of MedicineUNIVERSITY OF CALIFORNIA, LOS ANGELES

Analysis of most prescribed drugs is no surprise

April 24, 2011

Analysis of:What Drug Did Doctors Prescribe Most Last Year? | blogs.wsj.com

In times of cost constrains this is no concern. There are additional factors to explain the numbers, some of them related to FDA wisdom:-       Multiple new drug applications in metabolic area have been turned down-       Propoxiphene was withdrawn increasing dramatically the use of hydrocodone-       Atorvastatin is already generic in other countries Others are related to strategy of the Pharmaceuticals:-       Lipitor keeps the market share against simvastatin by issuing $4.00 coupons-       Advair and Plavix are heavily advertized directly to the consumer As fewer drugs are approved and many drugs are getting old the overall picture is a logical consequence.

Marc HametClinical ProfessorCOLUMBIA UNIVERSITY

Its all about the spin

August 21, 2008

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

This article could easily be spun as a victory for stent efficacy.

Jack RubinMedical Director and Chief Executive Officer Los Angeles Vascular Center

Tekturan losers blood pressure and proteinuria simultaneously

May 27, 2008

Analysis of:New data show Tekturna HCT® is twice as effective at reducing blood pressure than the diuretic HCT alone | www.novartis.com

While no more would argue that control of systolic hypertension is crucial to preventing the consequences of hypertension such as congestive heart failure, MI's, left ventricular hyperthrophy, stroke and kidney failure there are other factors that are associated with these disease states. One of these is proteinuria.

Forrest RubensteinCardiac, Thoracic and Vascular SurgeonST. MARY'S HOSPITAL, STREATOR, OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Preventing Bariatric Surgery Deaths

January 25, 2008

Analysis of:Pinning Down Mortality Rates After Bariatric Surgery | www.medscape.com

 Bariatric surgery is a major operative procedure that caries significant morbidity and mortality risks due to the comorbid diseases seen in this patient population.  This procedure is increasing in frequency as more patients are willing to have it and more surgeons are becoming proficient. The mortality rate is ~ 1 % at 1 year and 6% at 5 years which is greater than the population at large.

Dan StrejaClinical Professor of MedicineUNIVERSITY OF CALIFORNIA, LOS ANGELES

Outsourcing of compassionate use of drugs?

January 18, 2008

Analysis of: No right to experimental drugs for dying patients: Supreme Court | news.yahoo.com

The Supreme Court has rejected the use of experimental drugs by the dying patients on the grounds that "The framers (of the US constitution) understood that the pursuit of life is an inalienable right that should not be abridged without due process of law." Over the years our patients with terminal illness have traveled outside the US to purchase hope when our management was offering none. Although in the majority of cases the hope was unjustified, the current decision will encourage healthcare providers residing outside the US to advertise for their services through the internet. The issue should be addressed by the legislators sooner rather than later. Drugs who improve quality of life, awaiting approval for survival indication or drugs looking promising in early clinical trials could be made available to dying patients with informed consent addressing our limitations.  

Ramin EbrahimiDirector of Cardiac Catheterization LabWadsworth VA Medical Center

Risk Versus Benefit

November 23, 2007

Analysis of:Study Shows Weight-Loss Drug Rimonabant is Associated with Severe Adverse Psychiatric Events | pharmalive.com

The pooled analysis of Rimonabant trials point to a significant increase in psychiatric disorders. These studies also point to significant improvements in markers of cardiovascular risk. Risks versus benefits must be considered before the final decision is made on this class of medications.

John HewettPartnerPacific Interventional

Speech Recognition in it's Adolescence

September 4, 2007

Analysis of:Philips SpeechMagic Used In Largest Deployment Of Front-End Radiology Speech Recognition In The UK | www.medicalnewstoday.com

Despite large advances in the utility of speech recognition in medicine, the stated benefits are not fully achieved at this time.  The development of this technology promises significant cost savings and improvements in efficiency especially in the radiology department.  The maturation of this technology will be an important symbiosis to the maturation of imaging and other workflow technologies in radiology.  The key to successful use of speech recognition is judicious implementation.

Ramin EbrahimiDirector of Cardiac Catheterization LabWadsworth VA Medical Center

Good device but not much improvement.

August 31, 2007

Analysis of:St. Jude Medical Announces Japanese Approval Of The Angio-Seal STS Plus Vascular Closure Device | www.medicalnewstoday.com

The repositioning of the hole, also present with the VIP version is a mild improvement to decrease sheath manipulation. Otherwise the device has not changed much in the past few years. While a very good device in general, its primary limitaions listed below still remain. 1. not allowing re-access at the previous access site within 90 days of the index procedure  2. inability to promote means for primary healing of the arteriotomy site (primary healing results in much less scar formation and secondary healing that angioseal provides) and 3. relying on an intravascular component for deployment that stays within the vessel for weeks prior to its resolution  Newer devices such as the STARCLOSE that also are easy to deploy, rely on no intravascular components and potentially provide much better healing process may be the way of future.   

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