Health and Medical News and Resources

General interest items edited by Janice Flahiff

[NY Times Article] Risk Calculator for Cholesterol Appears Flawed

From the 17 November 2013 article at the NY Times

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with anonline calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.

“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

The controversy set off turmoil at the annual meeting of theAmerican Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.

Dr. Sidney Smith, the executive chairman of the guideline committee, said the associations would examine the flaws found in the calculator and determine if changes were needed. “We need to see if the concerns raised are substantive,” he said in a telephone interview on Sunday. “Do there need to be changes?”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal.

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November 18, 2013 Posted by | health care | , , , , , , , , | Leave a comment

Towards a smarter drugs policy | Addiction & Recovery News

Development of a rational scale to assess the ...

IA rational scale to assess the harm of drugs. Data source is the March 24, 2007 article: Nutt, David, Leslie A King, William Saulsbury, Colin Blakemore. "Development of a rational scale to assess the harm of drugs of potential misuse" The Lancet 2007; 369:1047-1053. (PMID 17382831; doi:10.1016/S0140-6736(07)60464-4)

Towards a smarter drugs policy | Addiction & Recovery News

From the 8 January 2012 Addiction and Recovery News blog posting

The new issue of the Lancet focuses on drug policy***. One piece offers key points for formulating policy:

  • Drug policy should aim to promote the public good by improving individual and public health, neighbourhood safety, and community and family cohesion, and by reducing crime.
  • The effectiveness of most drug supply control policies is unknown because little assessment has been done, and very little evidence exists for the effectiveness of alternative development programmes in source countries.
  • Supply controls can result in higher drug prices, which can reduce drug initiation and use but these changes can be difficult to maintain.
  • Wide-scale arrests and imprisonments have restricted effectiveness, but drug testing of individuals under criminal justice supervision, accompanied by specific, immediate, and brief sentences (eg, overnight), produce substantial reductions in drug use and offending.
  • Prescription regimens minimise but do not eliminate non-medical use of psychoactive prescription drugs. Prescription monitoring systems can reduce inappropriate prescribing.
  • Screening and brief intervention programmes have, on average, only small effects, but can be widely applied and are probably cost-effective.
  • The collective value of school, family, and community prevention programmes is appraised differently by different stakeholders.
  • The provision of opiate substitution therapy for addicted individuals has strong evidence of effectiveness, although poor quality of provision reduces benefit. Peer-based self-help organisations are strongly championed and widely available, but have been poorly researched until the past two decades.
  • Health and social services for drug users covering a range of treatments, including needle and syringe exchange programmes, improve drug users’ health and benefit the broader community by reducing transmission of and mortality due to infectious disease.

It’s good stuff. I particularly like its willingness to give credit where credit is due. For example, supply control can help but the benefits are often unstable and have a lot of unintended consequences. I also like the affirmation of the diversity of perspectives on the benefits of policies…..

Read the entire article

*** The Lancet site has abstracts of the articles. Full text access is by paid subscription only.
For suggestions on how to get the articles for free or at low cost, click here.

However, the Lancet site for these articles has  

  • An 8 minute video interview featuring one of the authors – Drug policy and the public good: evidence for effective interventions
  • An 11 minute MP3 Video where Author Wayne Hall discusses the series with Richard Lane

January 10, 2012 Posted by | Public Health | , , , | 1 Comment

   

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