That story about heartburn drugs like Nexium, Prilosec and other proton-pump inhibitors interfering with the cardio-protective effects of Plavix is growing legs.

Before Thanksgiving, Medco Health Solutions presented the results of a retrospective study of Plavix following stent placement and angioplasty.

In the study, patients taking PPIs and Plavix sustained 50% more heart attacks and other cardiac events than those just taking Plavix.

Now, Michael Ho and colleagues from the Denver VA are reporting that acute coronary syndrome patients who received both drugs had a 25% higher risk of death or readmission for the same syndrome as those receiving Plavix alone.

64% of the patients in Ho’s study were discharged on both drugs. 

Ho’s study was also retrospective. It appears in JAMA.

The authors concluded that PPIs should only be prescribed for Plavix-popping patients who have a “a clear indication for the medication” rather than using them prophylacticly, as has become common.

There are theories to explain the association. One fingers common metabolic pathways in the liver. Another proposes that the PPIs directly interfere with Plavix’ antiplatelet effects.

But it’s also possible that PPI use is nothing but a marker for sick patients who are more likely to have a lousy outcome anyway.

Issam Moussa of Weill Medical College at Cornell observed in fact that the patients who received PPIs in Ho’s study “were older, and had more comorbidities than patients who didn’t.”

The controversy moved the Brigham’s Chris Cannon to review data from his prospective CREDO study, which showed Plavix to be useful following coronary stenting.

Cannon’s review turned up “no evidence of increased risk for (the combo),” so now the whole thing is a mess.

Plavix is co-marketed by Sanofi-Aventis and Bristol-Meyers Squibb.

It did $4 plus billion in sales last year.

AZ’s Nexium came in at $5.5 billion.

A new survey of national innovation and competitiveness puts the US sixth among 40 nations. Singapore leads the pack.

The Washington-based Information Technology & Innovation Foundation ranked countries using indicators in 6 categories:  economic performance, economic policy, entrepreneurship, human capital, innovation capacity and IT infrastructure.

Singapore came out on top or near the top for dozens of indicators, notably the ease of doing business and trade balance. The city-state’s trade balance as a percentage of GDP is a plus 29%, while the US’ stands at -6%.

The US aced GDP per working age adult at $ 83,422, and was second in a photo finish on key indicators like e-government, productivity and contributions to global scientific and technical publications.
 
But we scored only 7th in broadband connectivity and were dead last in corporate tax rates, with a whopping 32%. Ireland topped that category at 9.6%.

The Foundation lauds Singapore, where, according to the report technological innovation has become a “national obsession.” 

“The rise of global economic competition means that the United States (needs to) proactively put in place national or continental economic development strategies,” the report warned.
 
The Foundation’s methodology differs from those in other analyses because it relies on hard data only, foregoing surveys. It also controls for country size rather than relying on aggregate data, according to BurrillReport.
 
To improve its standing, the Foundation recommends that the US enact tax incentives that stimulate R&D, welcome highly skilled immigrants, foster entrepreneurship development programs and expand funding for university research, among other things.
 
Sweden came in second in the survey, followed by Luxembourg, Denmark, and South Korea. The EU limped in at 18.

With the dentist shortage nearing crisis proportions in Maine, 2 of the state’s primary care residencies have begun to train physicians how to do simple dental procedures like lancing abscesses and pulling teeth.

The Pine Tree state has 4 times more physicians than dentists and that means there’s  only one dentist for every 2,300 people.

The national average is a dentist per 1,600 people.

“Doctors typically say, ‘say aah,’ take a look at the back of the throat and are done,” William Alto told the New York Times.  Alto is a physician at the Maine Dartmouth Family Practice Residency in Fairfield, home to one of Maine’s dental clinics for medical residents.

Maine is a largely rural state and dental school grads are even less prone to opt for such practice settings than their med school brethren. It doesn’t help that the state has no dental schools; the closest ones are in Boston, an hours’ drive with a tailwind from the state’s southernmost point.

Since Maine’s dental training programs began in 2005, 2/3 of residents graduating from these particular programs have set up shop in rural or remote areas.

“I see dental complaints all the time,” Andrew Fletcher confirmed for the Times. Fletcher learned some dentistry during his medical residency and now works up near the Canadian border.

“It’s mostly Medicaid patients who don’t have money to see dentists,” he added.

The Maine Dental Association supports the program but would rather recruit real dentists to the state. Said executive director Frances Miliano, “medical residents are only going to be doing this in dire circumstances. It’s not a total solution by any means.”