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.”

Years ago, Vermont guitarist Diana Levine lost her arm and her livelihood to gangrene after a health provider administered a nausea drug improperly.

Levine argued in state court that drug maker Wyeth should have affixed stronger warnings to the drug’s label.

Wyeth countered that the FDA approved the drug label and that should preempt state law.

The jury awarded Levine $7 million.

Wyeth appealed to the Supreme Court and last week, the Court ruled for Levine by a score of 6-3.

Writing for the majority, John Paul Stevens said that “Congress did not intend FDA oversight to be the exclusive means of ensuring drug safety and effectiveness.”

He added the FDA has “limited resources” with which to regulate the 11,000 or so drugs on the market.

“State tort suits…provide incentives for drug manufacturers to disclose safety risks promptly,” he added.

The decision amounted to a righteous whuppin’ for Big Pharma, which knew a positive ruling could short circuit a world of trouble in state courts where thousands of patients allege they have been harmed by more drugs than most can count.

In a conference call, Levine said the verdict brought her “unrestrained joy,” according to the Washington Post. “Next to getting my hand back, it’s the best they could do.”

Joining Stevens in support of Levine were Stephen Breyer, Ruth Bader Ginsburg, Anthony Kennedy, David Souter and Clarence Thomas.

Samuel Alito dissented, saying the case, “illustrates that tragic facts make bad law. The court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.”

“And the FDA conveys its warnings with one voice, rather than whipsawing the medical community with 50 (or more) potentially conflicting ones.”

“After today’s ruling, parochialism may prevail,” Alito predicted.

Fifty-three percent of Americans reported cutting back on health care to save money in the past year, according to the most recent Kaiser Family Foundation tracking poll. 

For 35% of them, this meant using home remedies and OTC drugs in lieu of a visit to the doctor.

The same percentage reported deferring dental care. Meanwhile, 21% said they chose not to fill a prescription, and 15% cut pills or skipped doses of prescription drugs.

The poll also revealed that 19% of respondents “experienced serious financial problems recently due to family medical bills.”

A shocking 13% indicate they’ve drawn down all or most of their savings paying off medical bills in the past year. The same number say health care bills make it hard to pay other bills. Twelve percent report being contacted by collection agencies.

Nearly 40% of respondents are very worried about their capacity to pay for needed health care, and that number bumps to 57% in the subset who think someone in the household might lose their job in the next 12 months.

A third of respondents with health coverage worry they will lose it.

“It’s clear that what the public wants most from health reform is relief from health care costs,” concluded Drew Altman, Kaiser’s President and CEO.

“Today’s economic anxieties have created a better starting point for health reform than we saw last time around,” he continued.

“More people see themselves benefiting from reform and fewer see themselves being negatively affected than we saw in the Clinton health reform debate.“

The Kaiser telephone interview survey was conducted from February 3-12 using a nationally representative sample of 1,204 adults.

Third graders that got 15 minutes or more of recess per day had better classroom behavior than those who were continually holed up in school, according to a study in Pediatrics.

To reach this conclusion, Romina Barros and colleagues from the Albert Einstein College of Medicine examined the records of 11,000 children from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999.

The scientists relied on teacher’s ratings of kids’ behavior.

Thirty percent of children in the study received no or minimal recess. These kids were more likely to be black, belong to a lower socioeconomic status, reside in the city and attend public school.

Even with these variables stewing in multivariate analysis, the beneficial association between recess and salutary classroom behavior remained significant.

Barros wants the word out. “Kids need that break because the brain needs that break,” she told the New York Times.

In fact, “recess should be part of the curriculum,” Barros emphasized. “You don’t punish a kid by having them miss math class, so kids shouldn’t be punished by not getting recess.”

Barros’ findings are consistent with recent studies of middle school students which revealed a direct relation between the number of fitness tests passed by children and their academic performance.

Another recent study of kids with attention deficit hyperactivity disorder showed that brief promenades improved attention and concentration as much as a slug of medication.

Scientists believe that people can concentrate on work, reading or exams for so only long before fatiguing.

Getting away from it all, even for short periods, appears to give aching brains time to reboot.

Four years ago a Harvard Medical School student smelled a rat when his pharmacology lecturer waxed on and on about the benefits of cholesterol busting drugs and then came on a bit too strong towards a classmate who had queried about their side effects.

Matt Zerden did a little snooping and it turned out the professor was bankrolled by 10 drug companies including 5 that made cholesterol drugs.

One thing led to another and now 200 HMS students and a handful of sympathetic faculty are on a mission to expose and limit industry influence in the classroom and who knows, maybe the labs and HMS’ 17 teaching hospitals as well.

This hasn’t phased HMS dean Jeffrey Flier who actually agrees things need to be tightened up a bit. He just tasked a committee to look at the school’s conflict-of-interest policies.

Flier had received a research grant for half a mil from Bristol-Myers Squibb and had consulted to 3 Cambridge biotech firms before accepting his new position 17 months ago. He unclipped those links before signing on as dean and hasn’t forged any new ones since.

According to the New York Times, that’s in contrast to his predecessor Joe Martin, who sat on Baxter International’s board for 5 years while he was in at dean for HMS.

For his efforts, Martin received up to nearly $200K a year from Baxter, piled nice and high on top of his HMS salary.

The activist HMS students have already secured passage of a blanket policy requiring that lecturers disclose industry ties in class, but this is an uphill battle.

For example, 1,600 HMS lecturers have told the dean either they or a family member have financial ties to a business related to their patient care, teaching or research.

And then there are the industry-endowed chairs, faculty prizes in the name of drug companies, Big Pharma-subsidized training programs taught by faculty on the take from…Big Pharma, and so on.

For decades, folks in Libby, Montana knew the fine dusty stuff that covered everything in town from big rigs to baseball fields was asbestos.
 
They knew where it was coming from, too. Right over there, wafting out of the W. R. Grace mine on the other side of town.

NBD. Just part of life, they assumed. No one told them otherwise.

Lifetime resident Helen Bundrock remembers Grace “called it a nuisance dust, (they) did.”

Helen, her husband and 4 of their 5 children have been diagnosed with asbestosis, a slowly progressive lung disease that is associated with mesothelioma and premature death.

Turns out the medical community and who knows, maybe some mining companies knew about the risks of asbestos for decades.

Now, Federal prosecutors have put the mining company on trial. They claim asbestosis sickened at least 1,000 residents of Libby Montana, and killed 200 more.

“There’s never been a case where so many people were sickened or killed by environmental crime,” says David Uhlmann, said the Justice Department’s former top prosecutor.

The Feds allege that until 1990, the company conspired to “knowingly release” asbestos and that it failed to reveal the risks to employees and residents, leaving them “in imminent danger of death or serious bodily injury.”

Grace faces fines of up to $280 million if convicted. Several executives could end up in jail.

Grace doesn’t deny that asbestos emanated from the mine nor that some were sickened and died. But it “categorically denies any criminal wrongdoing.” In fact Grace says, as information about the problem became known, it acted to mitigate the risk and communicate openly about it.

The trial is expected to last four months.

That Canadian study showing colonoscopy screening wasn’t as effective as first thought caused quite a dust up around the New Year, but consensus remains strong that the Big Easy is a life-saver and people need to get it done.

Yet only 60% of eligible patients report being up-to-date with the test and harried physicians often don’t have the time to discuss preventive services with their patients.

Which is why the results of a trial of a decidedly low-tech reminder system are so heartening.

Thomas Sequist and colleagues from the Brigham implemented a randomized trial of mailed reminders to patients and lo and behold, they actually improved colonoscopy utilization!

The scientists enrolled 21,860 patients between the ages 50-80 from 11 clinics during 2006-2007. All patients were overdue for the ‘scope.

Subjects either received nothing or a mailing that contained an educational pamphlet, a fecal occult blood testing pad, and instructions for scheduling a colonoscopy.

The scientists also sent electronic reminders to the patients’ primary care physicians.

Among patients who received the mailed reminders, 44% got it done. The number was 38% in the control group.

Reminders were increasingly effective as subjects got older, with the difference favoring the reminded group rising from 3.7% for ages 50 to 59 to 10.1% for ages 70 to 80.

The study is in the Archives of Internal Medicine.

“Our findings underscore that informed patients can play an active role in completing effective preventive services,” the scientists concluded.

Interestingly, the electronic reminders to physicians didn’t boost colonoscopy rates, “in part because over one-third of patients had no visits with their primary care physician during the 15-month study period,” the scientists reported.

Thirty years after Chevy Chase kept telling the world what it already knew about the fate of Spain’s fascist dictator, the nation’s Socialist government wants to remove from public display hundreds of statues, monuments and emblems throughout the country that commemorate his rule.

In fact Prime Minister José Luis Rodríguez Zapatero’s government has passed a law mandating that they be expunged.

That doesn’t sit well with Sinforiano Bezanilla, a city employee who was 11 when Franco died, but who boned up on the man and liked what he read.

Franco saved Spain from communism and elevated the Catholic Church to an exalted status in daily life, he emphasizes. In today’s Spain abortion, divorce and gay marriage are all legal.

“A lot of people are afraid to express themselves,” Bezanilla wailed to the Wall Street Journal. “The left is attempting to rewrite our country’s history. They base it on a series of half-lies, half-truths and outright lies.” 

Never mind that Franco’s Nationalist thugs slaughtered tens of thousands of foes after prevailing in a civil war that itself cost 500,000 lives. Or that they sent tens of thousands more to forced labor camps while giving their children away to families who supported the regime.

When Franco died, Spain’s fledgling democracy didn’t put his generals on trial as Latin American nations did, nor did it organize Truth and Reconciliation Commissions like South Africa.

The passivity all but assured the bitter ideological divisions would fester for generations.

In fact Spain’s ambivalence can be heard every time Real Madrid takes the pitch.

Years ago, Spanish politicians decreed that a certain phrase in its national anthem that reminded many of the repressive dictator’s rule would be deleted: “Raise your arms, sons of the Spanish people.”

But the pols couldn’t decide on a suitable replacement, so nowadays Spaniards either roll their own lyrics or just hum along.