In a blog at metabolism.com several months ago, website visitors were asked to join an email campaign addressed to Dr. Mack Harrell, President of the American Association of Clinical Endocrinologists (AACE). The purpose was to ask help reversing the existing practice recommendation # 22.4 published by the AACE in 2012, calling for a ban on the use of Armour Thyroid in the treatment of hypothyroidism. With over 800 individuals participating, the campaign appears to have achieved some success as the latest AACE treatment guidelines released last month no longer stipulate that desiccated thyroid is unfit for treatment of hypothyroidism. Instead the statement is issued, “ We recommend that levothyroxine be considered as routine care for patients with primary hypothyroidism, in preference to use of thyroid extracts. “, and…. “ Furthermore, there are potential safety concerns related to the use of thyroid extracts, such as the presence of supraphysiologic (unnaturally elevated, ed.) serum T3 levels and paucity of long-term safety outcome data.” Continue reading
by Gary Pepper, M.D.
“New is not always better.” This caution seems reasonable when considering the value of the recently approved medications for treatment of Type 2 (adult type) diabetes. These drugs include three new classes of medication referred to as GLP-1 analogs, DPP-4 inhibitors and most recently SGLT-2 inhibitors. The focus of this discussion will be the most widely prescribed of the newcomers, the DPP-4 inhibitors.
The first thing consumers will notice about the new diabetes medications are their TV commercial friendly names, Januvia, Onglyza, Tradjenta, and Nesina. Mix these newcomer drugs together into a single pill with the venerable low cost generic metformin and the names becomes Janumet, Kombiglyze, Jentadueto, and Kazano.
The next thing a consumer will notice is the price tag. At the local pharmacy in Jupiter, Florida the retail price of a 3 month supply of Januvia, Onglyza or Tradjenta are all about $1100. A three month supply of the established generic drug, glipizide, is $9.99 and metformin is between zero and $41. Continue reading
by Dr. S. Brown
Less than a year ago, Glaxo-SmithKline made a public pledge to stop using physicians as paid promoters of their pharmaceutical products. Now, with the release of their new diabetes product, Tanzeum, GSK also released a list of 168 freshly minted physician lecturers, specifically trained to promote the new drug.
As of yet, no other company has joined in the effort to clean up physician marketing of new drug products. Perhaps it became clear to the pharmaceutical giant that using doctors to promote their products was just too successful a tactic to give up, particularly if the competition refused to abide by the new rules.
Coincidentally, in the 2014, September 2 issue of the Annals of Internal Medicine (Ann Int Med 2014; 161 (5): 363-363), Jerry Avorn, M.D. of Harvard University, authored an opinion piece Continue reading
by Dr. S. Brown
As a physician in private practice familiar with highly skilled pharmaceutical representatives pitching the latest (and most expensive) medications, I am fairly good at separating truth from salesmanship. These clear cut interactions with the drug reps visiting my office are relatively harmless. Drug maker’s are now changing up the game however, with a new, more subversive tactic to influence doctors’ prescribing habits.
I have been compiling a “medical propaganda” file, consisting of emails directed to my work and personal address offering cash for my time. In less than a year, I count over 500 of these emails. Here are twenty from the past week. Some details are blacked out for legal reasons. Continue reading
by Gary Pepper, M.D.
According to government estimates, 4.6% of the US population aged 12 or more has hypothyroidism (low thyroid function). Based on treatment guidelines published in 2012 by the American Association of Clinical Endocrinologists (AACE), only synthetic thyroid hormone (levothyroxine, Synthroid, Levoxyl) is an appropriate therapy for this condition. According to these guidelines, the biologic product Armour Thyroid, is unfit for this treatment purpose. Armour Thyroid, an extract of porcine thyroid, has been available as a treatment for hypothyroidism for about 100 years. It was first used in the U.S. to treat hypothyroidism in 1892, a year after it was introduced into the United Kingdom. The impact of the AACE guidelines is more than symbolic Continue reading
Early in May 2014 a patient being treated with Armour Thyroid (desiccated thyroid) for hypothyroidism reported that her pharmacy service would not refill her prescription for Armour Thyroid because it was an “illegal” drug. We were both very distressed to learn of this, but for different reasons. My patient was rightfully concerned that she might be receiving a wildly inappropriate medication, while I was concerned that I might not be able to prescribe a medication I knew to be extremely helpful and safe. Continue reading
In the past “Bioflavonoids” were often referred collectively as vitamin P. Bioflavonoids are a group of naturally occurring plant compounds, which act primarily in nature as plant pigments, metabolic enhancers, chemical messengers within the plant and also fight various plant infections. In humans, they exhibit a host of biological activities, most notably powerful antioxidant properties. More than 5,000 bioflavonoids have been identified as of now. Continue reading
by Gary Pepper, M.D. and Andrew Levine, Pre-Med, Univ of Central Florida
The recently published TODAY study found obesity related type-2 diabetes mellitus (T2DM) is more severe as a teen than as an adult, and high risk of developing diabetes could be tied to weight gain at an early age.
Between 2004 and 2009 the “Treatment Options for Type 2 Diabetes in Youth Study Group” (TODAY) gathered 700 participants who met the American Diabetes Association’s criteria for this disease. The participants were monitored for between two to six years. TODAY’s goal was to assess treatment options and the clinical progression of obesity related T2DM in youth. The mean age of the 700 participants in the TODAY study was thirteen, the majority being female. Sixty percent of the 700 participants were African American or Hispanic, with the remainder being Caucasian. The mean duration of diabetes for the study’s’ participants was less than seven months. A major worrisome finding from the study is a majority of participants were also discovered to have dyslipidemia, an abnormally high amount of fats (cholesterol, triglycerides) in the blood, as well as high blood pressure (hypertension). Continue reading
As most people trying to lose weight know, boosting your metabolism is critical to success. Metabolism is the system controlling the rate of breakdown of food into the necessary nutrients for proper function of the cells of the body. A slow metabolism will slow down the weight loss process, while having a faster metabolism well increase your body’s weight loss. Thus, you will want to boost metabolism as much as possible within healthy limits. Knowing what foods assist metabolism will be vital in the effort to achieve and maintain a desirable weight.
Carbohydrates are usually easy for the body to digest. Fiber however, is a non-digestible form of carbohydrate. The body usually doesn’t recognize the fact that it is non-digestible, and expends energy in an effort to break it down anyway. This will increase the amount of “passive” calories used up in the digestive effort. Carrots are a double win, being high in fiber and low in calories, a cup of raw carrots containing only 50 calories. According to Kristine Clark, professor and assistant director at Penn State University, because of the small amount of calories going in while a large amount being used up, eating high fiber vegetables such as carrots can result in an increase in metabolism.