Your PPI Might Kill You

Proton pump inhibitors (PPIs) are widely used in the U.S. to treat or prevent heartburn and ulcers. For example, omeprazole is the 6th most prescribed drug in the U.S. according to one source. PPIs reduce acid production by the stomach. But doesn’t it make sense that God or Nature gave us that stomach acid for a reason?

From the British Medical Journal:

Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.

Source: Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study | The BMJ

Click for UPI’s coverage.

If you suffer from frequent heatburn, try cutting down on carbohydrates.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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Will Healthcare Providers Be There for You When Ebola Breaks Out in the U.S.?

Hazmat-suited healthcare worker in a decontamination shower

Don’t count on nurse Aesop. I’m sure he’s not alone. Few healthcare providers got into the business to put their lives on the line every day. The Ebola virus is highly contagious and often lethal. Prevention of the spread of Ebola to healthcare providers and the general population requires high-level isolation units. Aesop says there are only 15 such beds in the U.S. (He calls them BL-IV beds). There are zero at most hospitals and zero in most cities.

We aren’t set up for this [virus], and we’re doing nothing to stop it getting here (rather the opposite in fact).

And when it does, after those first 15 beds are occupied, we’ve done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we’ve done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can’t bullshit me or countless other doctors, nurses, and ancillary staff who’ll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we’re standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can’t collect paychecks at Forest Lawn [cemetery], and I won’t be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you’ll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly – by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO’s lackadaisical clipboard commandos – we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.There’s just death.

I’ll do my damnedest to save your life if you come into my ER.

But I won’t kill myself to do it, and I won’t die for you because TPTB [the powers that be] at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain’t in my contract, and unlike joining the Marines, I took no such oath, and it isn’t part of the deal.

I don’t know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Source: Raconteur Report: Where The Problem Is

Have a great day! 🙂

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Denninger on Price-Fixing In the Drug Marketplace

All Karl below:

Time to stop being nice.

America, you’re being raped.  Flat-out raped.

15 USC Chapter 1 makes clear that price-fixing is illegal.  When it comes to drugs, which are physical commodities, Robinson-Patman (15 USC Chapter 1, Section 13) also makes discriminatory pricing illegal for buyers of like kind and quantity.

(a) Price; selection of customers It shall be unlawful for any person engaged in commerce, in the course of such commerce, either directly or indirectly, to discriminate in price between different purchasers of commodities of like grade and quality, where either or any of the purchases involved in such discrimination are in commerce, where such commodities are sold for use, consumption, or resale within the United States or any Territory thereof or the District of Columbia or any insular possession or other place under the jurisdiction of the United States, and where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly in any line of commerce, or to injure, destroy, or prevent competition with any person who either grants or knowingly receives the benefit of such discrimination, or with customers of either of them

It is illegal for a pharmacy to charge you $10 for a drug and someone else $100.  Or, for that matter, to charge one person $2.15 million and another a $100 copay.

It is illegal for a hospital to do the same thing.

Things like “GoodRX” and similar are flat out facial violations of the law.

So are “varying” co-pays for the same drug in the same quantity.

So, for that matter, are bribes on a differential basis for the same thing (Section 13 c, d and e)

So, for that matter, are inducing such practices or benefiting from same (Section 13 f)

An insurance company is never a consumer of the drug.  A person is.  Such practices as conspiring with pharmacies and hospitals to vary the price you pay is illegal and has been since the 1930s.

Never mind the first few Sections of 15 USC Chapter 1 which make any scheme to fix prices or lessen competition irrespective of upon whom the price injury falls, or even whether it occurs (proof of same is not required in the statute) a criminal, 10 year in prison, felony.

Drug prices in particular, since drugs are commodities, fall under Robinson-Patman.  There is no exception found in the statutes for drugs.

Source: Prison Or Gallows: Pick One – The Market Ticker

Well worth your time to read the whole thing.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

 

Interval Training Beats Continuous Exercise for Fat Burning

From JAMA Network:

Exercisers can burn slightly more body fat with interval training than moderate-intensity continuous training, according to a recent systematic review and meta-analysis in the British Journal of Sports Medicine. Although the differences in fat loss weren’t huge, the interval workouts were shorter, which could make it easier for people to adhere to them.

Source: For Fat Burning, Interval Training Beats Continuous Exercise | Lifestyle Behaviors | JAMA | JAMA Network

I discuss both types of training in my book.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Memories: Sense of Smell Must Be Wired Directly Into the Hippocampus

Have you ever smelled something that instantly brought back a strong memory?

Whenever I smell wax-leaf ligustrum blossoms in the spring, it takes me back to my childhood in Houston, TX.

img_3787

Here’s to you, Uncle Hank

I thought I’d try a whisky less expensive than Jamesons, so I brought home a bottle of Jim Beam Kentucky Straight Bourbon Whiskey. The first whiff immediately transported me back to age 12, Baytown, TX, and thoughts of my favorite uncle, Hank Tarski.

I don’t know what Hank drank, but I’m guessin’ Jim Beam.

Hank was quite a guy. I loved him. He was Polish and worked as a chemist at one of the petroleum plants in Baytown. Was he a fighter pilot in WW2, or did I imagine that? He had a beautiful huge mustache, smoked a pipe, had a waterfront house on Black Duck Bay. Hank’s laugh was infectious, and got louder the more he drank.

One of my strongest memories of him was when he took me and his sons fishing in a small boat on one of the local waterways. I still remember catching catfish and croakers; they were small but that doesn’t matter to an adolescent boy.

I also remember falling asleep upstairs with my siblings and cousins while Hank and Kay and my parents downstairs stayed up late talking and laughing, sometimes shouting! We could only imagine the muffled topics of adult conversation. This was the 1960s.

Hank died of pancreatic cancer ten or 15 years ago. I miss him very much.

—Steve

PS. I almost named my son Henry, and we’d have called him Hank.

Nobody Gets Out Alive: Sugary Beverages Increase Risk of Death

From JAMA Network:

Question:  Is the consumption of sugary beverages (ie, sugar-sweetened beverages and fruit juices) associated with an increased mortality risk?

Findings:  In this cohort study of 13 440 black and white adults 45 years and older observed for a mean of 6.0 years, each additional 12-oz serving/d of sugary beverages was associated with an 11% higher all-cause mortality risk, and each additional 12-oz serving/d of fruit juice was associated with a 24% higher all-cause mortality risk. Similar associations were not observed for sugary beverage consumption and coronary heart disease mortality.

Meaning:  These results suggest higher consumption of sugary beverages, including fruit juice, is associated with increased mortality.

Source: Association of Sugary Beverage Consumption With Mortality Risk in US Adults: A Secondary Analysis of Data From the REGARDS Study | Cardiology | JAMA Network Open | JAMA Network

Steve Parker MD, Advanced Mediterranean Diet

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Avoid Ultra-Processed Foods to Help With Weight Management

From Cell Metabolism:

We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (−2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.

Source: Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake: Cell Metabolism

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com