two medicines in one pill for blood pressure? Back to the 1980s

guess what? A single pill with two drugs treats blood pressure better than two pills.

SciDaily report:

The guidelines recommend starting most patients on two blood pressure lowering drugs, not one. The previous recommendation was for step-wise treatment, which meant starting with one drug then adding a second and third if needed. This suffered from "physician inertia," in which doctors were reluctant to change the initial strategy despite its lack of success. At least 80% of patients should have been upgraded to two drugs, yet most remained on one drug. 

well, it's not "lack of success" but that there is partial success, and we figure that was good enough.

so now they think putting two pills together might work better... and this is related to why docs figure one pill was good enough: Because patients object to taking a lot of pills, or forget to take them correctly:

 It is now recognised that a major reason for poor rates of blood pressure control is that patients do not take their pills. Non-adherence increases with the number of pills, so administering the two drugs (or three if needed) in a single tablet "could transform blood pressure control rates," state the guidelines.

the problem? We used to have these combinations back in the 1980s, but some "expert" at the FDA outlawed them, saying that it was more scientific to give separate pills so we could individualize the doses. But we docs knew about the patients not taking pills, but never mind: The experts had spoken.

Ebola in Africa

the latest ebola epidemic isn't making a lot of headlines.

LINK

The Ebola outbreak in the Democratic Republic of the Congo's (DRC's) North Kivu district continues to grow, amid new healthcare worker infections and concerns that regional violence is making surveillance and detection challenging for international aid workers. According to an update released late yesterday by the DRC's healthy ministry, Ebola cases now total 96 (5 new cases), with 69 confirmed. In addition, 55 people have died. The 5 new cases and 5 newly recorded deaths are all in Mabalako health zone.

Electric catfish therapy

Improbable research discusses electric fish therapy.

Aristotle, Pliny, and Plutarch recognized the numbing effect of electricity when referring to the application of the torpedo fish to the body. Scribonius Largus advocated the use of piscine electrotherapy for the relief of pain associated with gout, headache, arthritis, and hemorrhoids. Various means of providing electrical current were developed, including the use of the electric ray or great Nile catfish.“

more here about the great Nile catfish here. 

The Egyptians reputedly used the electric shock from them when treating arthritis pain.[9] They would use only smaller fish, as a large fish may generate an electric shock from 300 to 400 volts. The Egyptians have depicted the fish in their mural paintings and elsewhere;[8] the first known depiction of an electric catfish is on a slate palette of the predynastic Egyptian ruler, Narmer, about 3100 BC.[7] It was suitably called "angry catfish" in ancient Egyptian. An account of its electric properties was given by an Arab physician of the 12th century; then as now, the fish was known by the suggestive name of raad, abo el raash, el raad or raash, which means "thunder"[8] (literally "trembler" or "shaker").

but beware the electric eels, whose shocks are more dangerous.


giving electric stimulation for pain is used in rehabilitation: And arthritis responds to this (probably in the same way that linaments and other irritants help wih the pain).

WAPO article on athlete who uses electric patches for his arthritis.

 The Arthritis foundation discusses here.

medical analysis of electrical stimulation for Rheumatoid Arthritis.

The results showed that ES had significant benefit when compared to a control no treatment group in terms of muscle strength and fatigue resistance of the first dorsal interosseous. Most favourable results were obtained by using a patterned stimulation derived from a fatigued motor unit of the first dorsal interosseous in a normal hand rather than a fixed 10 Hz stimulation frequency. Side effects of the ES application were not reported.

Homones and trans

I had to take hormones for endometriosis.

the pill made me depressed.

The stronger medicine with androgenic properties made me "fat hairy and horny"... luckily I couldn't afford the full dosage or I would have gone manic and started to attack men.

The final medicine I took turned off my hormones and made me severely depressed. I cried all the time.

(So when I had men with prostate cancer who were put on this hormone, I warned them. I wonder how many of them ended up committing suicide? Or drinking for depression etc)

The emotional side effects of birth control pills are rarely discussed, but then as a woman with ovarian problems, I can tell you my own hormones did the same thing. PMS anyone?

I could tell my period was due when I would cry over nothing.

In the good old days, men with prostate cancer often were placed on estrogen: Cheap and efficient. Why did we stop using this? Because a double blind study showed the death rate on estrogen was higher for men: Not from cancer, where the death rate was lower, but from cardiovascular disease.

So this article (Via Virtueonline, an Episcopal webpage) notes the dirty little secret that no one wants to discuss, lest they enrage the twittermob or lose their job:

Hormones for transsexuals have side effects.

The US study compared medical records of over 5,000 transgender people against more than 97,000 others. It also suggested that men who took hormones for more than six years were ten times more likely to have a stroke caused by a blood clot than the general population. 'Risks' The study concluded: "These results may indicate the need for increasing vigilance in identifying long-term vascular side effects of oestrogen therapy". Senior author Michael Goodman of Emory University's Rollins School of Public Health said the findings could be "taken into consideration when planning follow-up and evaluation of patients". "The confirmation of this risk is good to have so patients can be warned", added fellow author Dr Joshua Safer.

this, presumably, was in adults.

The problem of giving various hormones and puberty blocking hormones to young teens with "gender dysphoria" is a bigger problem, because not only do many if not most of these kids have merely a transient wish to change sexes, and change their mind later, but the long term health problems are not clear.

and not in the article:

the lowering sperm count is back in the news.

NYTimes article.

it discusses the drop in sperm count over the last 40 years, but actually it has been decreasing since the 1930's.

Estrogen in the water supply? Including phyto estrogens from plastics and herbicides and plants?

Chinese generic medicines and fake/counterfeit drug dangers

this is a big problem here: generics are cheaper but you don't know if they work.

Usually, if it is a major infection or something important, I buy brand names or brand name generics at Mercury drug store, which checks on their generics.

The cheaper generics? I use when not so important.

Once Lolo had an infection that didn't get better with generic cephalexin, and our niece said to get the brand name, and the infection promptly resolved. Since he had CLL and a poor immune system, this could have mean a life threatening infection: but the generic was not completely fake, so it merely kept the infection under control with a suboptimal dosage.

The art of medicine

from SD:

doctors often rely on "gut feelings" when treating patients.

This used to be called the "art" of medicine.

some of this is observation (small clues, ala Sherlock Holmes, or of body language), and knowledge of the patient's background/history/culture.



and some of it is sensing emotions in the patient (so the teenager coming in for a cold seems a bit worried, and yes she is pregnant).

Breast is best

We always encouraged our moms to breast feed, and one problem was when milk formula companies peddled their products to poor women.

But as the kids got older, the parents couldn't afford formula, so watered it down and the kids ended up malnourished and often vulnerable to die from infections.

So when I read the headlines claiming Trumpieboy opposed breast feeding, I thought "WTF?"

No, not because I suspected fake news (I am used to nuances being twisted by the MSM against Trumpieboy), but because public health docs have pushed to stop this for years at the local level.

So making it a UN resolution means lots of money for UN bureaucrats to push their weight around, but not much else.

and my other question was: This issue has been around for years (we opposed this in the early 1970s) so why did it come up now, at a time when people in third world countries are a lot richer, and there are a lot more women who need to work outside the home and use formula because they can't breastfeed?

This is what I found back in the 1970s: breastfeeding was universal in rural Zimbabwe, where babies often were not weaned until 2 years old, but in urban Liberia, the patients and nurses pointed out that these women needed to work and so needed formula to feed their babies.

Nowadays, here in the Philippines, they often breast feed for up to a year, but again often supplement the child's feeding with formula.

TV ads here for formula often only are about older kids, and do insist that breast feeding is better.

what has changed in the last 40 years is that people are now richer.

Yes, there are poor people, especially in war torn countries, but as a whole, there is a lot less poverty around.

And insisting on breast feeding until one year of age means women would not be able to hold a job outside the family. Back to the good old days!

Hmmm... this is the real "Handmaiden's tale".

The Federalist has the backstory and indeed it is "fake news".

“The Trump Administration believes it’s a public health priority that women and their families have all the information to decide how to appropriately deliver nutrition to their children, whether it is via breastfeeding or other methods,” an HHS spokesman said. The agency pointed out that the United States has a long history of supporting breastfeeding and breastfeeding programs, and is the largest bilateral donor of foreign assistance programs in this area. Exclusive breastfeeding rates have doubled across 20 of countries where these programs have focused between 1990 and 2014, they say. The U.S. also supports complementary feeding programs and accurate description of the same as a matter of long-standing policy. The original resolution would have made that policy goal difficult, officials said.