News & Views Newletter
edited by Jack Nicholas, cornishpro@aol.co

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 2 ISSUE 18 August 15, 2002
PSORIATIC ARTHRITIS MEDICAL NEWS

ARTHRITIS IS A LIFE SENTENCE FOR GORDON GOV'T RECOGNIZES IMPACT OF 9 BN ILLNESS
By Frank Wilkie - and published in the SUNSHINE COAST DAILY on July 24, 2002

To see the photo of Gordon Eliott that accompanied this article, use the following: http://photos.groups.yahoo.com/group/PsoriaticArthritis/lst

Photo Caption: RECOGNITION AT LAST: The Australian Government has recognized arthritis as a major health concern. Bli Bli's Gordon Eliott and others are looking forward to receiving support.

Bli Bli's Gordon Eliott was 39 when he developed an unusual form of arthritis that would change his life forever.

Over the past 23 years, psoriatic arthritis has attacked the retiree's joints and spine. Mr Eliott needs to take strong pain killing medication five times a day and can only walk on elbow crutches.

Mr Eliott said the Federal Government's decision last week to recognize the condition as a national health priority equal to cardiovascular disease and cancer was satisfying.

"Over three million Australians have arthritis and it's the leading cause of chronic pain and disability," Mr Eliott said.

Priority rating means collaboration between governments and clinical, non-government and consumer groups. One area of concern is the disease's health burden, estimated to be $9 billion a year. Arthritis now rates alongside cardiovascular disease and stroke, cancer, diabetes, asthma, mental health and injury prevention as health priorities.

• Arthritis refers to the degeneration or inflammation of a joint.
• Osteoarthritis usually affects the hands and large weight-bearing joints of the body, such as the knees, hips and ankles.
• Rheumatoid arthritis is an auto-immune disease that causes inflammation in the joints. Signs of rheumatoid arthritis include swelling in three or more joints, swelling of the hands or wrists, bumps under the skin and morning stiffness.

HEALTH PRIORITY

As a person severely disabled by arthritis, I have previously had letters published of the need for greater government recognition and action regarding this disease.

I am pleased to advise that on July 19, the Federal Health Minister declared arthritis to be a national health priority, ranking alongside cardiovascular diseases and cancer control.

However, we still require public support to have the new biological agent drugs for arthritis, so successful overseas, listed on the PBS.

They are expensive, at $18,000 per year per person, but we are arguing that they could be prescribed on a restricted basis where all else has failed and could only be prescribed by a medical specialist in the field, with supporting medical evidence.

GORDON ELIOTT
Bli Bli

Editors Note: Thanks to our fellow member Gordon Eliott for working so diligently in behalf of all the people in Australia who suffer from various forms of arthritis.

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EXERCISE THERAPY IMPROVES FIBROMYALGIA
July 29, 2002 - (British Medical Journal)

Prescribed graded aerobic exercise is a simple, cheap, and effective treatment for people with fibromyalgia (medically unexplained chronic muscular pain and joint tenderness), finds a study in this week's BMJ.

Researchers identified 132 patients with fibromyalgia who were attending a hospital rheumatology clinic between January 1997 and June 1998. Patients were then randomly assigned to either aerobic exercise classes or relaxation classes, twice weekly for 12 weeks. The classes were carried out by personal trainers with no special experience in providing exercise for people with ill health.

Compared to relaxation, exercise led to significantly more participants rating themselves as much or very much better at three months. Benefits were also maintained or improved one year later.

These results show that a three-month program of prescribed graded aerobic exercise is an effective treatment that leads to improvements in health status, say the authors. Furthermore, prescribed exercise can be undertaken effectively in the community by personal trainers previously inexperienced in managing people with ill health.

However, compliance with exercise treatment is a considerable problem, giving high drop out rates, says the authors.

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FTC SEEKS GENERIC DRUG DELAY LIMITS - July 30, 2002 Washington (AP)

The Federal Trade Commission wants to limit the ability of drug companies to delay the marketing of generic competitors and to require the firms to disclose agreements covering the sales of generic drugs.

"The commission's recommendations today are designed to accomplish two goals: to facilitate generic entry and to maintain appropriate incentives for the development of new drug products," said FTC chairman Timothy J. Muris.

American consumers benefit from both innovation in drugs and the marketing of generic versions, he noted.

The proposals stem from a study of whether pharmaceutical companies keep lower-cost generics off the market.

When the Food and Drug Administration approve a generic for sale, the first company to market it is allowed 180 days of sales before another competitor is approved. The FTC has expressed concerns that brand-name companies either make payments to the generic company to delay marketing, or make some other agreement to "park" those sales for a time.

The FTC has filed complaints against drug-makers for allegedly entering into agreements that effectively stopped generic forms of brand-name drugs from coming to market.

However, in one case earlier this month, an administrative judge dismissed the agency's complaint that alleged pharmaceutical giant Schering-Plough Corp. conspired with Upsher-Smith Laboratories to keep a generic drug off the market.

In that case, the FTC alleged that Schering, the maker of K-Dur 20, a widely prescribed potassium chloride supplement, paid Upsher-Smith millions of dollars to delay the sale of a cheaper, generic version of the drug.

But D. Michael Chappell, an FTC administrative law judge, said in his ruling that the "violations alleged in the (FTC) complaint have not been proven."

In the report issued Tuesday, the FTC recommended legislation requiring that brand-name companies and the first generic applicant to sell a drug provide it with copies of any agreements they make.

The agency also recommended that brand-name companies not be allowed more than one 30-month delay of a generic competitor through filing a patent infringement lawsuit.

Such suits generate an automatic delay of up to 30 months and once that has expired there have been cases of brand-name drug makers filing a second suit on a different issue.

The agency said eight generic drugs have been delayed through this tactic, six since 1998. In each of four cases that have been ruled on, the agency said, the court has found the patent claim invalid or not infringed.

Nonetheless, the suit had the effect of delaying the sales of the cheaper drug, the agency said.

Over the next few years, drugs with nearly $20 billion in annual sales in the United States will go off-patent.

Copyright 2002 The Associated Press.

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ANOTHER 3 BILLION DOLLAR HOAX - By Stuart Elliott

Madison Avenue, facing growing legislative threats to one of the advertising industry's most lucrative categories, is stepping up the fight to protect its freedom to pitch prescription drugs directly to consumers.

Drug companies, agencies and their media allies who have benefited handsomely from the flood of ads beat back one recent measure in the House of Representatives. But advocacy organizations on the other side of the issue vow to continue battling to limit or even eliminate such campaigns, and one senator has introduced legislation that would limit the pharmaceutical industry's tax deduction for such advertising.

The category of direct-to-consumer ads did not even exist until five years ago. Before 1997, broad curbs prevented pharmaceutical makers from mounting any significant efforts, and they aimed most of their spending directly at health care professionals.

But since the Food and Drug Administration loosened its strictures against those ads, primarily by making it much easier to promote drugs with commercials, the category has boomed. It has become an estimated $3 billion-a-year business for the media. That exceeds the amount spent annually to advertise many drugs sold over the counter like analgesics and vitamins, according to CMR, a division of Taylor Nelson Sofres that tracks ad spending.

The spending for the direct-to-consumer drug campaigns, which come complete with the traditional trappings of brand advertising like celebrity endorsers, jingles, free samples and slogans, also exceeds the yearly outlays in mainstay marketing categories like insurance and real estate, apparel and alcoholic beverages.

Agencies are anxious to keep that revenue flowing as they struggle to recover from the worst advertising recession in decades. They and their clients, the drug companies, are also eager to keep open a channel that has significantly stimulated demand and sales.

Indeed, in a survey last month by the Ipsos marketing research company, 25 percent of respondents said they had been prompted by direct-to-consumer ads to call or visit a doctor to discuss the product being advertised. Moreover, 15 percent of respondents reported requesting the very drug that was the subject of the ad.

That is one-reason opponents castigate direct-to-consumer ads, decrying them as unfairly influencing important health care decisions about powerful medicines that ought not to be sold with the same sophisticated marketing ploys used to peddle movies, soft drinks or fast food.

"The stuff done to promote drugs works, and because it works, it's doing a disservice to the patient," said Sidney Wolfe, director for the health research group of Public Citizen, an advocacy organization in Washington. "The doctors are frequently as misled as the patients are," he added.

One doctor, J. Edward Hill - the new chairman of the American Medical Association in Chicago - offered another complaint. "We have no policy that opposes direct-to-consumer advertising, mainly because of freedom-of-speech issues," Dr. Hill said. "However, we do have some big concerns about advertising getting in the middle of the patient-physician relationship.

"It's sometimes even creating an adversarial relationship," he added, "when the patient insists on an advertised medicine but the doctor believes it's not the best or most effective medicine."

The agencies are being joined by lobbyists for media that would lose ad revenue if Congress tightened rules for direct-to-consumer ads. At one time, some magazine and newspaper publishers perceived television and radio as rivals for ad revenue from makers of prescription drugs, but the media are now working together.

New York Times July 12, 2002

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The following editorial comments about the July 12th article in the New York Times, are written by Dr. Joseph Mercola MD, who has a very popular medical website.

Drug companies will spend over three billion dollars this year to advertise their drugs to consumers. That is a lot of money. Compared to their returns, though, it is next to nothing.

This three billion dollar investment is targeted directly at consumers to further distort their minds into believing that a drug approach is the best s olution for their health problems. It's a three billion dollar investment to keep consumers three billion light years from the truth. Natural health clinicians, meanwhile, don't have billions, or millions, or for that matter tens of thousands of dollars, to advertise to the contrary. But we do, at least, have our voices, and a medium like the Internet on which to share it. And so I'll share this piece of advice:

Don't let these pharmaceutical ads with all their pastel colors, pretty people, and pleasant music fool you. Don't read the ads, don't watch the ads, don't listen to the ads. They are a waste of time. Worse, they are dangerous.

Americans spent will spend over 500 billion dollars on drugs this year.

Who out there is naïve enough to believe that American are getting half a trillion dollars of benefits from these pharmaceuticals?

You can, and should, call drug companies a lot of negative things - but you can't call them stupid. Through lobbyists and other pressure tactics, they have pushed the government to change the rules so they can now market directly to consumers. It certainly has worked! 2/3 of doctor visits now result in a drug being prescribed. Spending for prescription drugs is the fastest-growing category of health care expenditures. But because doctors have been molded into this over-reliance on using pharmaceuticals as Band-Aids - versus seeking and treating the cause of the problem -- physicians are now the third leading cause of death in the U.S.!

Newsletter Editor Request: I am asking that you sit down with a paper and pen some evening soon, and list each Pharmaceutical ad you see for both non-prescription and prescription products during the course of an evening of television viewing. Please send me a direct e-mail with your results (Cornishpro@aol.com), and I will publish the data in the next newsletter. A good starting point is the evening news on any of the major networks. List the products and the number of times you saw the ad for each product. Include total viewing hours too. Thanks for helping. Results should be very interesting and revealing.

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WINE DRINKERS HAVE HEALTHIER LIFESTYLES
July 25, 2002 - (American Journal of Clinical Nutrition)

People who consume alcohol in moderation are healthier, yet the relationship between alcoholic beverage preference and health benefit or risk has not been extensively investigated. In a new study published in the American Journal of Clinical Nutrition, Barefoot et. al. surveyed alcoholic beverage preference in a large and homogeneous group of highly educated upper-income Americans and found that beverage choice has implications beyond the relative physiological benefits of alcohol.

Wine drinking has consistently been associated with reductions in cardiova scular risk due to the presence of polyphenols in wine, but in the current study wine drinking was additionally correlated with healthier overall dietary and lifestyle choices. Conversely, the authors suggest that concurrent diet and lifestyle patterns may explain the higher rates of morbidity and mortality among nondrinkers.

The 2,864 men and 1,571 women participants, averaging 48 years old, were part of the University of North Carolina Alumni Heart Study, a long-term investigation of cardiovascular risk with a special emphasis on psychosocial variables. The study population was unique in that the subjects had a wide variety of alcoholic beverage preference (beer, wine, spirits, or no preference); and they were 99% Caucasian, affluent, highly educated, and from the same geographic region.

Health and lifestyle differences were greatest between participants who preferred wine and those who preferred other alcoholic beverages or were abstainers. Women reported healthier dietary habits than men, regardless of alcoholic beverage choice. Men and women who preferred wine consistently consumed less saturated fat and cholesterol, smoked less, and exercised more than those who preferred beer, spirits, or had no preference. Abstainers, who made up 20% of the subjects, have been shown in previous studies to have higher disease and death rates than moderate drinkers. Negative health and lifestyle factors among the abstaining subjects, including lower intake of fruits and vegetables and higher rates of smoking and red meat consumption, may explain why non-drinkers have poorer health than drinkers.

An implication of the study is that the benefits of wine drinking may not be merely physiological; preferring wine as an alcoholic beverage may be part of an overall pattern that leads to better health. The authors suggest that future research might focus on dietary and lifestyle differences between those who drink and those who abstain, as well as on the relative health advantages of alcoholic beverage choices.

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INFLAMMATION MAY BE MORE IMPORTANT THAN CHOLESTEROL AT TRIGGERING HEART ATTACKS CNN.com, August 4, 2002

New evidence has found low-grade inflammation hidden deep within the body is a common trigger for heart attacks, even when clogging of the arteries is minimal. A series of landmark studies conducted by Paul Ridker, MD and his team of researchers found those with high levels of C-reactive protein, a chemical that increases during inflammation, have twice the risk of heart attack than people with elevated cholesterol. "It means we have an entire other way of treating, targeting and preventing heart disease that was essentially missed because of our focus solely on cholesterol," noted Dr. Ridker. The Centers for Disease Control and Prevention and the American Heart Association held a meeting in March to review the scientific evidence and make recommendations. Physicians involved in drafting the recommendations, to be released in the fall, indicate they will almost certainly recommend broad testing for inflammation especially among those considered at mild to moderate risk of heart attacks. Inflammation can be measured with an inexpensive test that looks for high levels of C-reactive protein.

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PERSONAL HEALTH METHODS ARE MANY TO REDUCE BLOOD PRESSURE July 2, 2002 (The New York Times News Service)

Three decades after the National High Blood Pressure Education Program started saying that controlling high blood pressure saves lives, rates of hypertension are rising.

In addition, the proportion of patients being treated - or treated well enough to bring their blood pressure readings under control - is falling, creating waves of alarm among cardiovascular specialists.

As a result, stroke rates are going up and the decline in heart attacks has leveled off; both strokes and heart attacks are directly linked to uncontrolled hypertension.

In trying to account for these changes, experts point to a number of factors. One is the sharp increase in the percentage of Americans who are overweight or obese, creating for themselves the leading risk factor for hypertension.

Another is a basic quality of the condition: It is a silent disease, and vast majorities of people with it feel fine, even as it causes life-threatening or fatal damage. About 30 percent of people with hypertension do not know they have it.

A third factor is the unwillingness or inability of most people with high blood pressure to change their diets and try exercise and relaxation techniques that can bring their readings down to normal.

Fourth is the reluctance of many patients to take medications and the failure of many doctors to keep up with drug developments that would allow them to design individual treatments and prescribe the remedies likely to produce the most benefit with the fewest side effects.

Further complicating the picture are the insurance-dictated constraints on doctors. Many of them don't take the time to educate patients about the importance of continually monitoring their pressure readings.

Last but hardly least, the drug companies with the greatest financial interest in getting all people with hypertension into treatment may have had a detrimental effect on the acceptance of drug therapy.

At the expense of older, less expensive drugs, pharmaceutical companies have heavily promoted newer and more expensive medications that may not always be the best for a particular patient. These may also be too costly for many older patients, who, since Medicare does not pay for drugs, have been known to take half the prescribed dosages to stay within their budget.

There are six classes of medications and scores of different drugs and drug combinations that are tailored to control high blood pressure.

Which drug or drug combination is right, is determined by factors like sex, age, systolic blood pressure (the higher number, representing the pressure on arteries when the heart beats), smoking habits, total cholesterol, level of protective HDL cholesterol, and whether the patient has diabetes or an enlarged left ventricle, the heart's main pumping chamber.

The simplest remedy that achieves the desired goal is the best choice. For example, say most experts, among them Dr. Steven A. Dosh of Escanaba, Mich., patients who have no known underlying disease are best treated initially with diuretics, which bring blood pressure down by reducing the volume of fluid the heart has to pump to outlying tissues. Diuretics in low doses are well tolerated, safe, effective and cheap and need be taken only once a day.

But, as Dosh wrote recently in The Journal of Family Practice, for those who have already had a heart attack or are otherwise known to have coronary artery disease, beta-blockers, which slow the heart and reduce the force of its contractions, may be the initial drug of choice. When combined with a diuretic, beta-blockers were proved to be especially good at preventing strokes, though less effective than expected in preventing heart attacks, according to Dr. Michael Alderman, a hypertension specialist at Albert Einstein Medical Center in the Bronx.

But one newer, more expensive drug may be better for some patients. For example, for patients with diabetes or systolic hypertension after a heart attack, the best remedy may be ACE, or angiotensin-converting enzyme, inhibitors. They relax blood vessels by reducing production of angiotensin I, which is converted into angiotensin II, a hormone that constricts arteries.

If an ACE inhibitor's side effects - a cough and a rash - are troublesome, a patient could try an ARB or angiotensin receptor blocker, which prevents the action of angiotensin II. Thus far, the ARB's appear to be more effective than beta-blockers in preventing strokes, though the drugs are equally effective in reducing blood pressure, Alderman said.

The other classes are vasodilators, which relax blood vessels, and calcium channel blockers, which also relax blood vessels but in a number of studies have been linked to an increased risk of cardiovascular disease, especially congestive heart failure. However, studies have also indicated that long-acting calcium channel blockers may be more effective at preventing strokes than the ACE inhibitors, Alderman said.

So far, neither the ACE inhibitors nor the calcium channel blockers have been shown to be better than diuretics in preventing heart attacks, he added.

First, don't do what one woman in her 50s did. Having experienced swollen ankles and a rapid heart beat as a side effect of a calcium channel blocker prescribed for hypertension, she stopped taking the drug and never returned to the doctor.

All drugs have side effects, a fact especially troublesome for blood pressure treatment, since the disorder itself usually produces no symptoms. Diuretics in high doses force patients to the bathroom many extra times a day and several times a night.

Many diuretics also deplete the body of potassium and magnesium and may raise blood levels of cholesterol and glucose. Beta-blockers in full dose can make people groggy, slow the heart rate and cause bronchial spasms.

Vasodilators can cause headaches, fluid retention and rapid heart rate. ACE inhibitors commonly cause an annoying dry cough, whereas the ARBs, which are generally better tolerated, may cause high blood levels of potassium. And nearly all the antihypertensive medications can inhibit sexual function, particularly in men.

Alderman suggested that in many patients, the ideal treatment is a combination of low doses of two or more drugs. This has the advantage of limiting the likelihood of disturbing side effects while increasing the drugs' effectiveness.

Patients should be closely monitored in the first months of treatment and every six months afterward; if the treatment is or becomes ineffective, it must be changed, by increasing the dose or changing drugs. Home blood pressure monitoring can alert patients to the need to see a doctor.

And for any drug treatment to work optimally, otherwise healthy patients should also adopt protective habits, including eating diets rich in fruits, vegetables and low-fat dairy products and low in fat and salt and other sources of sodium.

Aerobic exercise for at least 45 minutes a day three times a week is highly recommended. In addition, if the patient is overweight, a loss of 10 percent of total body weight can be very beneficial. Relaxation exercises like meditation may also help.

Copyright 2002 The New York Times News Service.

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NEW RESEARCH INDICATES HEART-HEALTHY LIFESTYLE COULD PREVENT ALZHEIMER'S
July 17, 2002 LONDON (AP)

Mounting evidence indicates that the same risk factors for heart disease - high blood pressure, diabetes, excess weight, high cholesterol and lack of exercise may also play a role in Alzheimer's disease.

A string of new studies to be presented next week at an international Alzheimer's conference in Stockholm establish the big picture for the first time, giving scientists a better understanding of how people may be able to reduce the liklihood of developing the disease.

Over the last few years, hints of a connection between Alzheimer's and lifestyle have emerged, but scientists have become increasingly interested in investigating such a link and are just now beginning to realize that what is good for the heart may also be good for the brain.

Alzheimer's is a degenerative brain disease that causes memory loss, disorientation, depression and decay of bodily functions. The disease afflicts about 12 million people worldwide, including more than 4 million Americans. It is increasing so fast that more than 22 million people worldwide will be affected by 2025, experts predict.

Scientists do not know what causes the sticky brain deposits that inevitably kill off neural cells until memory disintegrates and ultimately the patient dies. The biggest risk for Alzheimer's is simply age: Alzheimer's cases double with every five years of age between 65 and 85.

"While more research is necessary, especially in the form of prevention trials, we're seeing the strongest evidence yet that there is a relationship between healthy aging and a reduced risk of Alzheimer's," said William Thies, vice president of medical and scientific affairs at the Alzheimer's Association.

Several studies to be presented at the International Conference on Alzheimer's Disease and Related Disorders indicated that people may be able to reduce their chances of developing Alzheimer's by taking early steps to treat high blood pressure.

One study, by Miia Kivipelto of the University of Kuopio in Finland, examined 1,449 people after a follow-up of about 21 years. It found that the high cholesterol and high blood pressure seemed to be more strongly linked to the risk of developing Azheimer's than was a certain important gene variation.

However, it seems that having high blood pressure only in later life is not connected to Alzheimer's.

"Since high blood pressure can be controlled, we may have identified something people can do to lower their chance of developing Alzheimer's," said Thies, who was not connected with any of the research.

Three studies to be presented at the conference, the largest gathering in history of Alzheimer's researchers, bolster evidence that taking cholesterol-lowering drugs could reduce the chances of developing Alzheimer's.

A study by Dr. Robert Green at Boston University School of Medicine found that people taking cholesterol drugs called statins reduced their risk of getting Alzheimer's by 79 percent. With 2,378 patients, it is the largest study to date to investigate the connection and the first to include large numbers of black people, who are disproportionately likely to develop Alzheimer's.

The study also found that types of cholesterol-lowering drugs other than statins, were not linked with a reduced risk of Alzheimer's.

High cholesterol can narrow the arteries and raise the risk of heart disease. Some researchers think high cholesterol may also affect brain arteries and promote the clumping of the protein beta-amyloid, which is thought to damage the brain in Alzheimer's.

Beta-amyloid is a normal substance in the body, but it can accumulate in the spaces between brain cells and create plaques in the brain. These plaques are linked to the death of brain cells, causing a gradual loss of memory and control of body function, and leading eventually to death. By the time a patient has noticeable symptoms of Alzheimer's, substantial amounts of amyloid have built up in the brain, experts say.

A study to be presented at the conference by researchers at St. George's Medical School in London, found that statins dramatically reduced the production of beta-amyloid in a laboratory.

"The small amounts of beta-amyloid normally found in the blood of healthy people are quickly cleared from the brain," said the study's leader Brian Austen. "In the general population, people taking statins to reduce their blood cholesterol, for whatever reason, have a 70 percent reduction rate for Alzheimer's."

Advances in the understanding of how beta-amyloid plaques form in the brain has prompted researchers to focus much of their drug-creation effort on trying to block plaque formation.

An encouraging study to be discussed at the conference focused on a way of reducing plaque build up by targeting a larger protein from which the plaque comes.

Beta amyloid is made from a larger protein in a two-step process involving enzymes called beta secretase and gamma secretase.

Researchers from two drug companies, Eli Lilly and Co. and Elan pharmaceuticals, will discuss how treating Alzheimer's mice for 90 days with a substance that blocks the function of gamma secretase produced an 80-90 percent reduction in the level of beta amyloid, without any bad side effects.

Other research highlights of the conference involve new ways of seeing what's going on inside the brains of Alzheimer's patients. Until recently, Alzheimer's could only really be confirmed when the brain is examined in an autospy.

One study outlines how a new dye injected into people could show doctors where the plaques are when the brain is scanned. The study, conducted by scientists at Uppsala University in Sweden, found the dye went to areas of the brain where plaques are usually seen in autopsies and that very little of the dye lingered in the brains of the people who had no mental impairment.

"Having the ability to quantify amyloid deposition in the brain will have a profound impact on our ability to monitor the progression of Alzeimer's as well as gauge the effectiveness of medical treatments," said Thies of the Alzheimer's Association.

The conference, in Stockholm will involve about 4,000 Alzheimer's researchers.

Copyright 2002 The Associated Press.

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I hope you enjoyed this issue, and please feel free to e-mail me with your comments and suggestions for future issues. This is YOUR newsletter and if you can, please help with our TV survey.

Good Health to All

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2002 8/15/2002-18