Once the superstar of the medical world and the number one darling of doctors for the treatment of diabetes, Avandia is now a big disgrace. The image of Britney Spears comes to mind when considering this story. After all, the rise and fall of Avandia does make for great tabloid reading. Avandia reached the market as a one of a kind treatment for diabetes and within a few years was at the top of the heap making billions of dollars for its maker GlaxoSmithKline. In the past few years there has been a vague undercurrent of trouble with this drug including limited availability, due to what Glaxo said were problems with its manufacture. The company blamed it on hurricane damage to its factory. Then came the sudden, dramatic tumble from the top when the media broke the story of a possible ugly side to this beauty (http://blog.metabolism.com/2007/10/01/the-avandia-debate-common-sense-required/).
Now Avandia and its maker can’t seem to get out of their own way. Stories have circulated about mishandling of data, and intimidation of Avandia’s critics by Glaxo. Most recently the search for culprits has brought other celebs such as Bill Gates into the circus spotlight.
Meanwhile, not even a kind word from the FDA can restore Avandia’s former glitter. Doctors all over the country have turned their backs on their former darling and are even snickering among themselves about the scandal. It seems like Avandia has followed closely in the footsteps of Britney Spears. I wonder when it will be that the paparazzi snaps a picture of the Avandia box in a compromised position in a seedy nightclub.
Researchers already know that ten different viruses can cause obesity in animals. Recent information presented at a conference in Boston by Dr. Nikhil Dhurandhar and colleagues, pin-points adenovirus-36 as a potential cause of obesity in humans. In the latest studies these researchers were able to convert human stem cells into fat cells by infecting them with the adenovirus. By converting human stem cells into fat (adipose) cells adenovirus-36 can cause an increase in the amount of fat tissue in the body. The adenovirus is a common infection in infants and children causing flu like symptoms of sore throat, runny nose, cough, diarrhea and fever. Pink-eye (conjunctivitis) can also be caused by adenovirus. Once a cell is converted to a fat cell by the virus it may remain in that form for its entire existence.
Studies in which humans have been infected with adenovirus-36 have not been conducted although it was found that 30% of people with evidence of prior infection with adenovirus-36 were obese.
Studies implicating viral infection as a contributor to obesity raise the question if a vaccine against the culprit viruses could be developed in the future. If successful vaccination might then be a way to help people protect themselves against developing obesity. The researchers point out that although viruses might increase fat cells in the body, a lifestyle of over consumption of calories or sedentary lifestyle is also needed to complete the conversion to obesity.
I was most impressed by the reserved tone the FDA used in describing the risk. Based on the types of articles already published by some leaders in the field of diabetes, it wouldn’t have been out of the question for the FDA to have Avandia withdrawn from the market. Instead the FDA chose to include the term “potential” when describing the risk of heart attack associated with using Avandia. The FDA also explains that there isn’t enough data at present to say that Avandia creates an increased risk of heart attack compared to other diabetes drugs and that further studies are necessary to clarify this.
Finally, the FDA adds that at present no diabetes drug is associated with a reduced risk of heart attack. In my opinion this is a slap at the makers of Actos (Takeda Pharmaceuticals) , the direct competitor of Avandia in the diabetes market. Takeda has recently been heavily promoting a single study which seems to indicate a potential heart benefit of their drug, Actos.
My overall impression is that this is a win for GSK, the makers of Avandia in that the warning is a lot milder than it might have been and that it moves to silence the makers of Actos who appear to be making the most of the negative publicity surrounding the Avandia controversy.
Over the past few years the use of estrogen to treat post menopausal women has plunged in popularity. This occurred after the release of several major studies showing that instead of helping older women avoid arteriosclerosis (hardening of the arteries) and heart attacks the opposite was true. Recent studies showed that women taking estrogen after menopause were more likely to have heart attacks. Additionally, there has been a persistent concern that estrogen use is tied to increased risk of certain cancers, particularly breast and uterine cancer.
For most women, this knowledge was sufficiently convincing for them to stop using estrogen or to decide not to start.
When it comes to a hormone as complex in its action as estrogen there is a lot more to this story, however. A recently published study in the journal Neurology from the Mayo Clinic shows that women who undergo premature menopause due to surgical removal of one or both ovaries and who don’t receive estrogen replacement, have a significantly higher risk of developing memory loss, dementia (senility) and Parkinson’s Disease in later years. The younger the woman at the time of menopause the greater the risk of later brain dysfunction.
The benefit of estrogen use on brain function seems to end around the age of 50 years. The study did not address women who have spontaneous menopause before the age of 50. Is it possible that this group of women need to take estrogen to reduce the risk of developing brain damage as they grow older?
I am unaware of any study which answers this question. For any woman who wants to know if they should take estrogen, it is advised they confer with their own physician since the controversy and personal issues are so complex.
Recent information published in the British medical journal Lancet, supports using calcium and vitamin D supplementation to prevent fractures and bone loss in older people. A 12% reduction in bone fractures linked to osteoporosis was seen in people aged 50 and older who used calcium and Vitamin D supplements. Osteoporotic fractures are common with one in six people over the age of 50 experiencing this type of fracture in their lifetime. In people over 70, the occurence of a bone fracture, particularly of the hip is associated with a very high risk of mortality. One study showed a one year mortality of about 33% in elderly people after hip fracture. To achieve the bone benefits from supplements the researchers recommend a daily dose of 1,200 mg of calcium and 800 IU of vitamin D for people over 50.
The staff of metabolism.com wants to add a warning to people shopping for calcium and vitamin D supplementation. When shopping for these items be aware that there is a great variation in price among the various brands of supplements. The higher price brands often claim to be significantly better than cheaper competitors in terms of absorption and results. Be aware that many of these claims are false or exaggerated. Why spend $12 for 50 coral calcium pills when 100 Tums (calcium carbonate) can be gotten for half the price? If coral calcium is actually 20% better absorbed then calcium carbonate then an extra Tums per day will more than balance off any difference.