Blood-Thinner Pradaxa: What You Should Know

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Blood-Thinner Pradaxa: What You Should Know.

Concerns about Pradaxa surfaced 2 years ago, he says, when doctors began reporting a larger number of serious and sometimes fatal bleeding problems in older patients on the drug.

The claim by the company that the drug needs no blood-level monitoring is misguided, Moore says. “It turns out the company has had data for several years, showing the amount of anticoagulation [blood thinning] varied [from patient to patient] more than five-fold.”

That means, Moore says, that “the same dose could produce widely varying effects on blood clotting. Some patients would be at extremely high risk of bleeding. Others would not get a strong enough blood clotting effect to serve its purpose, reduce the risk of stroke.”

Do the phrases “serious and sometimes fatal bleeding problems”  combined with the drug maker’s withholding of data bother anyone?  And yet another example of putting profits before people.

Update 07.27.14

I found another fine article on the Pradaxa mess.  Follow the link to The Poison Review. There you will find more details on this story and more links for further reading, including a link to the full text BMJ article.

The Institute for Safe Medication Practices reported that in 2011 there were 3781 serious adverse effects and 542 patient deaths reported in the United States in association with dabigatran. In comparison, warfarin (Coumadin) was associated with only 72 deaths during that same time period. – See more at: http://www.thepoisonreview.com/2014/07/27/must-read-marketing-vs-medicine-in-the-case-of-pradaxa-dabigatran/#sthash.tpAapuE6.dpuf

Must-read: marketing vs. medicine in the case of Pradaxa dabigatran | The Poison Review.

Update 08.22.14

Getting the dabigatran Pradaxa story right… Correcting four common mistakes..

If you’re not totally confused by now you should be.

Stupidity is Worse for us than Either Sugar or Saturated Fat

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Stupidity is worse for us than either sugar or saturated fat.

Read this article and you’ll encounter a well reasoned rant with lots of links for further reading enjoyment.  My personal journey includes a significant weight loss experience in my early 20’s.  Over the years I’ve gained back some of the 200 plus pounds lost.  Over the years I’ve also gotten lazy with my dietary habits.  Too many calories and an aging metabolism is not a combination for staying trim.  So I got serious (again) and have dropped 12 pounds the past three months.  I’ve always known what to do but failed to do what needed to be done.

And so it goes.  Change. Adapt. Repeat.

Boomer Report – NIH-commissioned Census Bureau Report

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Email received and reproduced in its entirety.

NIH-commissioned Census Bureau report highlights effect of aging boomers

Data on individual, economic, social changes linked to dramatically aging population

While rates of smoking and excessive drinking have declined among older Americans, prevalence of chronic disease has risen, and many older Americans are unprepared to afford the costs of long-term care in a nursing home, according to a report from the U.S. Census Bureau commissioned by the National Institutes of Health.

The report highlights those trends and others among America’s older population, now over 40 million and expected to more than double by mid-century, growing to 83.7 million people and one-fifth of the U.S. population by 2050. Population trends and other national data about people 65 and older are presented in the report, 65+ in the United States: 2010 (PDF, 12.0M). It documents aging as quite varied in terms of how long people live, how well they age, their financial and educational status, their medical and long-term care and housing costs, where they live and with whom, and other factors important for aging and health.

Funded by the National Institute on Aging (NIA), part of NIH, the report draws heavily on data from the 2010 Census and other nationally representative surveys, such as the Current Population Survey, the American Community Survey and the National Health Interview Survey. In addition, data from NIA-funded research was included in the report.

“The National Institute on Aging is pleased to support this 65+ in the United States report,” said Richard Suzman, director of the Division of Behavioral and Social Research at NIA. “This report series uniquely combines Census Bureau and other federal statistics with findings from NIA-supported studies on aging. The collaboration with Census has been of great value in developing social, economic and demographic statistics on our aging population with this edition highlighting an approaching crisis in caregiving — since the baby boomers had fewer children compared to their parents.”

A key aspect of the report is the effect that the aging of the baby boom generation—those born between 1946 and 1964—will have on the U.S. population and on society in general. Baby boomers began to reach age 65 in 2011; between 2010 and 2020, the older generation is projected to grow more rapidly than in any other decade since 1900.

The report points out some critical health-related issues:

 

  • Rates of smoking and excessive alcohol consumption have declined among those 65 and older, but the percentage of overweight and obese people has increased. Between 2003-2006, 72 percent of older men and 67 percent of older women were overweight or obese. Obesity is associated in increased rates of diabetes, arthritis, and impaired mobility, and in some cases with higher death rates.
  • Research based on NIA’s Health and Retirement Study suggests that the prevalence of chronic diseases, such as high blood pressure, heart disease, chronic lung disease, and diabetes, increased among older people between 1998 and 2008. For example, in 2008, 41 percent of the older population had three or more chronic conditions, 51 percent had one or two, and only 8 percent had no chronic conditions.
  • The cost of long-term care varies by care setting. The average cost of a private room in a nursing home was $229 per day or $83,585 per year in 2010. Less than one-fifth of older people have the personal financial resources to live in a nursing home for more than three years and almost two-thirds cannot afford even one year. Medicare provides coverage in a skilled nursing facility to older and disabled patients for short time periods following hospitalization. Medicaid covers long-term care in certified facilities for qualifying low-income seniors. In 2006, Medicaid paid for 43 percent of long-term care.

“Most of the long-term care provided to older people today comes from unpaid family members and friends,” noted Suzman. “Baby boomers had far fewer children than their parents. Combined with higher divorce rates and disrupted family structures, this will result in fewer family members to provide long-term care in the future. This will become more serious as people live longer with conditions such as cancer, heart disease and Alzheimer’s.”

Other areas covered in the report include economic characteristics, geographic distribution, social and other characteristics. See highlights below.

“We hope this report will serve as a useful resource to policymakers, researchers, educators, students and the public at large,” said Enrique Lamas, the Census Bureau’s associate director for demographic programs. “We sought to develop a comprehensive reference with up-to-date information from a variety of reliable sources.”

About the National Institute on Aging (NIA): The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging, and health, go to www.nia.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery into Health

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65+ in the United States: 2010 (PDF, 12.0M)
Highlights

Population Characteristics

  • In 2010, there were 40.3 million people aged 65 and older, 12 times the number in 1900.
  • The percentage of the population aged 65 and over among the total population increased from 4.1 percent in 1900 to 13.0 percent in 2010 and is projected to reach 20.9 percent by 2050.
  • From 2010 onwards, the older dependency ratio—the number of people aged 65 and over per 100 people aged 20 to 64—is expected to rise sharply as the baby boomers enter the older ages. In 2030, when all baby boomers will have already passed age 65, the older dependency ratio is expected to be 37, which translates into fewer than three people of working age (20 to 64) to support every older person.
  • The older population has become more racially and ethnically diverse, with those identifying their race as white alone comprising 84.8 percent in 2010, down from 86.9 percent in 2000.

Health and Long-term Care

  • Over 38 percent of those aged 65 and over had one or more disabilities in 2010, with the most common difficulties being walking, climbing stairs and doing errands alone.
  • The share of the older population residing in skilled nursing facilities declined from 4.5 percent in 2000 to 3.1 percent in 2010. The share in other long-term care facilities, such as assisted living, has been growing.
  • Medicaid funds for long-term care have been shifting away from nursing homes with funding for home- and community-based services increasing from 13 percent of total funding in 1990 to 43 percent in 2007.
  • Changing marital trends, such as the rise of divorces, as well as the increase in living alone among the 65-and-over population, will likely alter the social support needs of aging baby boomers.

Economic Characteristics

  • Labor force participation rates rose for both older men and older women in the first decade of the 21st century, reaching 22.1 percent for older men and 13.8 percent for older women. In contrast, the labor force participation rates for the population aged 25 to 34 fell from 2000 to 2010 for both men and women.
  • The older white alone population was less likely than the older black alone and Asian alone populations to live in poverty. Older Hispanics were more likely to live in poverty than older non-Hispanic white alone residents.
  • Following the housing price peak in 2006, homeownership rates declined for the population under age 65 but remained flat for older householders.
  • Housing costs were slightly less of a burden in 2009 compared with 2001 for older householders.
  • Many older workers managed to stay employed during the recession. The population aged 65 and over was the only age group not to see a decline in its employment share from 2005 to 2010. In 2010, 16.2 percent of the population aged 65 and over were employed, up from 14.5 percent in 2005.

Geographic Distribution

  • Eleven states had more than 1 million people aged 65 and older in 2010.
  • States with the highest proportions of older people in their populations in 2010 included Florida, West Virginia, Maine, and Pennsylvania (all above 15 percent).
  • The West and South regions experienced the fastest growth in their 65-plus and 85-plus populations between 2000 and 2010.
  • In 2010, more than 7 out of 10 older Hispanics lived in four states: California (26.9 percent), Texas (19.2 percent), Florida (15.7 percent), and New York (9.0 percent).
  • The vast majority of older people do not move, but their moving rates remained stable between 2000 and 2010, in contrast to the slowdown in migration among younger populations.

Social Trends

  • The population aged 65 and over was the only age group to see an increase in voter participation in the 2012 presidential election compared with the 2008 presidential election.
  • In 2010, Internet usage among the older population was up 31 percentage points from a decade prior.
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Johns Hopkins Health Alert – Potassium and Sodium

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Reprinted from the original email.

Potassium and Sodium:
Achieving the Proper Balance

 Potassium is an important nutrient everyone needs, but if you have heart disease or are at risk for it, potassium takes on particular importance. Getting plenty of potassium from food is a wise move for most people. Others, however, may need to limit potassium in their diets, including those who are taking certain blood pressure or heart medications or have kidney disease.

Why potassium is important. Potassium is an electrolyte with many essential jobs: It helps conduct nerve impulses and muscle contractions, regulates the flow of fluids and nutrients into and out of body cells, and helps keep your blood pressure in check. Essentially, the level of potassium in your blood can make the difference between normal and abnormal activity in your heart and blood vessels.

Potassium does not act in a vacuum, though. It interacts with other electrolytes, including sodium. It’s long been known that sodium raises blood pressure, while potassium lowers it. But it’s becoming clearer that getting the right balance between sodium and potassium in the diet may be key to your heart health.

How much potassium do you need? In general, adults should get at least 4,700 mg of potassium daily, while limiting themselves to 1,500 mg of sodium. But most Americans are not meeting either goal.

Why is this? The main culprit is too many packaged and prepared foods. During processing, typically a large amount of salt (and, therefore, sodium) is added to foods, while any natural potassium may be stripped away. In contrast, many unprocessed whole foods — fruits and vegetables, in particular — contain adequate levels of potassium but little sodium.

In fact, the vast majority of salt in your diet comes not from your salt shaker, but from processed foods. And some of the biggest sources may surprise you: bread and rolls, prepared pasta dishes, and fresh poultry, for example. Others are less surprising — like cold cuts and cured meats, canned soups and sauces, and snack foods like chips, pretzels and popcorn. So you can optimize your potassium intake and minimize sodium intake by emphasizing fruits and vegetables, whole grains, low-fat dairy, beans, fish and lean meat in your daily diet.

Here are some examples of high-potassium foods followed by healthy alternatives that you can substitute:

  • High-potassium foods (at least 250 mg/serving): wholegrain breads, wheat bran and granola; peanut butter; fruits like apricots, bananas, melon, mango, oranges and pears; vegetables like potatoes, tomatoes and tomato sauces, parsnips, cooked spinach and broccoli, and raw carrots; milk and yogurt.
  • Low-potassium foods (less than 250 mg/serving): White bread and rice; some fruits like apples, berries, grapes, pears and peaches; some vegetables, such as asparagus, green beans, cooked carrots and cabbage, cauliflower, corn and eggplant; poultry, tuna and eggs.

It’s Official: The Boomerang Kids Won’t Leave – NYTimes.com

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It’s Official: The Boomerang Kids Won’t Leave – NYTimes.com.

One in five people in their 20s and early 30s is currently living with his or her parents. And 60 percent of all young adults receive financial support from them. That’s a significant increase from a generation ago, when only one in 10 young adults moved back home and few received financial support. The common explanation for the shift is that people born in the late 1980s and early 1990s came of age amid several unfortunate and overlapping economic trends. Those who graduated college as the housing market and financial system were imploding faced the highest debt burden of any graduating class in history. Nearly 45 percent of 25-year-olds, for instance, have outstanding loans, with an average debt above $20,000. (Kasinecz still has about $60,000 to go.) And more than half of recent college graduates are unemployed or underemployed, meaning they make substandard wages in jobs that don’t require a college degree. According to Lisa B. Kahn, an economist at Yale University, the negative impact of graduating into a recession never fully disappears. Even 20 years later, the people who graduated into the recession of the early ’80s were making substantially less money than people lucky enough to have graduated a few years afterward, when the economy was booming.

Read the entire article for a lesson in how to put a positive spin on our new Culture of Dependency.  Watch the slideshow of a dose of reality.  Then read the reader comments and decide for yourself if this “new and permanent life stage” is truly a “potentially thrilling economic evolution”.

Or not.