Saturday, March 17, 2007


It's been an interesting week in health care. Just a few highlights, in no particular order, in case you were paying more attention to the Alberto Gonzales shenanigans.
  • Low-acid coffee, like low-acid OJ, is now being marketed for people who have bad reflux. Not that there's really any evidence to support this. An excerpt from the NY Times article by Andrew Martin :

    A recent study by Stanford University researchers found that there was little scientific evidence to support the idea that eliminating coffee — and several other foods and drinks — helps cure persistent heartburn.

    “It’s as much mythology as anything,” said Dr. Joel E. Richter, chief of medicine at Temple University’s School of Medicine in Philadelphia and past president of the American College of Gastroenterology. “The evidence that coffee is injurious to the stomach isn’t there.”

    The Stanford study, that appeared in May in The Archives of Internal Medicine, evaluated published medical reports from 1975 to 2004 on heartburn.

    The study found that there was no evidence that giving up tobacco, alcohol, coffee, spicy foods, citrus or chocolate helped decrease heartburn, known to professionals as gastroesophageal reflux disease, or GERD.

    Research on coffee’s impact on the digestive system was contradictory, the Stanford study found. “Given the conflicting reported data, the relationship between caffeine and coffee and GERD remains unclear,” the study concluded. “There is insufficient evidence to support the routine recommendation that patients with GERD avoid such behavior.”

    Dr. Lauren B. Gerson, one of the study’s authors and the director of the Esophageal and Small Bowel Disorder Center at Stanford University, acknowledges that when patients complain that coffee irritates their stomachs, she tells them to stay away from it.

    But she questions the wisdom of routinely telling patients with acid reflux to stop eating certain foods, even though such advice is still offered by the National Institutes of Health and the American Gastroenterological Association.

    All I know is that when I eat garlic or tomato, I regret it. Luckily, coffee is not an issue for me. I don't know what I would do if it was. Isn't it funny how anecdote trumps evidence in an individual, if not a population?
  • Antidepressants don't help kleptomaniacs. Well, if you read the lay media coverage, that's the impression they give. However, if you read the fine print, the study published in the Journal of Clinical Psychiatry was a very small trial of Lexapro (escitalopram) vs placebo in 15 people diagnosed with kleptomania. No significant difference was found between the drug and placebo. Interestingly, this study was funded by the manufacturer of Lexapro. In case you wonder why any of this matters, there are an estimated 1.2 million kleptomaniacs in the U.S. alone.
  • The FDA is putting new warnings on sleeping pills (Ambien, Lunesta), confirming what many people chalked up to urban myth. From the NY Times article by Stephanie Saul:
    The review was prompted, in part, by queries to the agency from The New York Times last year, after some users of the most widely prescribed drug, Ambien, started complaining online and to their doctors about unusual reactions ranging from fairly benign sleepwalking episodes to hallucinations, violent outbursts, nocturnal binge eating and — most troubling of all — driving while asleep.

    Night eaters said they woke up to find Tostitos and Snickers wrappers in their beds, missing food, kitchen counters overflowing with flour from baking sprees, and even lighted stoves.

    Sleep-drivers reported frightening episodes in which they recalled going to bed, but woke up to find they had been arrested roadside in their underwear or nightclothes. The agency said that it was not aware of any deaths caused by sleep-driving.

    The reports gained credence from scientific studies. A forensic toxicologist in Wisconsin, Laura J. Liddicoat, gave a presentation at a national meeting on six instances of Ambien-impaired driving.

    And Dr. Carlos H. Schenck and Dr. Mark W. Mahowald of the University of Minnesota said that they had been studying cases of nearly 30 Ambien users who developed unusual nighttime eating disorders.

    Last May in Washington, Rep. Patrick Kennedy, Democrat of Rhode Island, blamed Ambien when he crashed his car near the Capitol building.

    The agency also received reports of people making phone calls, purchasing items over the Internet, or having sex under the influence of sleep medication.

    In each case the consumers had no recollection of the events, which they said had occurred after they took their pills and headed for bed.
  • Hillary Clinton and John Dingell (Dem, Michigan) introduced a bill that would expand CHIP (Children's Health Insurance Program). No matter what you think of Hillary, expanding health insurance coverage for kids is a fantastic idea.

    Under the bill, virtually all uninsured children would have access to coverage of some type, with or without federal subsidies. Mr. Dingell and Mrs. Clinton would give states financial incentives to cover children with family incomes up to four times the poverty level. A family of three is considered poor if its annual income is less than $17,170. Thus, the bill would allow the federal government to pay subsidies for coverage of children in a three-person family with annual income up to $68,680.

    That is higher than the limit in any state. In January, 24 states had limits at 200 percent of the poverty level, 10 had lower limits and 16 had higher ceilings. New Jersey covered children up to 350 percent of the poverty level. Gov. Eliot Spitzer of New York has proposed increasing the limit to 400 percent, from 250 percent.

    The latest budget request from President Bush would move in the opposite direction. He proposed reducing federal payments for children with family incomes above 200 percent of the poverty level, saying that would return the program to its “original objective.”

    Under the Dingell-Clinton bill, states could allow employers and parents to buy coverage through the Children’s Health Insurance Program. States could subsidize the premiums, and the federal government would help pay the cost in states that expanded their programs to cover children with family incomes up to four times the poverty level.

Not a complete round-up but at least food for thought. I didn't even mention the birth control pill ruling, as that will be a separate post when I am less irate.