Archive for December, 2012

Influenza Update USA and Europe

Monday, December 31, 2012 // Uncategorized

From ProMED Digest.  It certainly fits with my observations

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 29 Dec 2012
Source: The Washington Post, Associated Press report [edited]

The flu season in the United States is having its earliest start in
nearly a decade, and health officials say this season [2012-2013]
could be a bad one. Although flu is always unpredictable, the early
nature of the cases and the predominant type circulating this year
[2012] could make this a severe flu season, said officials at the
Centers for Disease Control and Prevention [CDC]. But officials said
the vaccine formulated for this year is well-matched to the strains of
the virus seen so far and urged those who have not been vaccinated to
get a flu shot.

In early December 2012, the CDC said it was noticing an increase in
flu activity about a month before authorities normally see it, and the
earliest since the 2003-2004 flu season. The primary strain this
season is H3N2, an influenza A virus that has been associated in the
past with more severe flu seasons.

Since the beginning of December [2012], “there has been increasing
influenza activity in more parts of the United States and more cases
of flu,” said Joe Bresee, chief of epidemiology at CDC’s influenza
division, in an interview last week. “We have seen increasing trends
that flu is increasing in the last few weeks of the year, and I
wouldn’t be surprised if we see that continue into the new year.”
Influenza often peaks in January, February or even later.

Reports of flu have been reported in 29 states, including Maryland and
Virginia. As of 15 Dec 2012, higher-than-normal reports of flu-like
illnesses had been reported in 12 states, most of them in the South
and Southeast. They are: Virginia, Alabama, Georgia, Louisiana,
Mississippi, Missouri, North and South Carolina, Tennessee, Texas,
Illinois and Utah.

Based on data from the past 2 decades, during the years when H3N2 is
the predominant flu strain, “there are more deaths and
hospitalizations,” Bresee said. It is not completely clear why. One
factor may be that the elderly, who are at high risk for flu
complications, tend to become sicker with the H3N2 strain than the
other 2 common flu strains, he said.

But this flu season offers 2 bits of good news as well. Of the flu
strains that are spreading this year [2012], about 80 percent are the
influenza A type, and almost all of those are the H3N2 strain, Bresee
said. That matches well with this year’s flu vaccine, which includes
the H3N2 strain. Flu vaccines are designed to protect against 3
influenza viruses that experts predict will be the most common during
the upcoming season. The 3 kinds of influenza viruses that commonly
circulate among people today are influenza B, influenza A (H1N1), and
influenza A (H3N2). Each year, one flu virus of each kind is used to
produce seasonal influenza vaccine.

Also, the Food and Drug Administration on 21 Dec 2012 expanded the
approved use of Tamiflu [a neuraminidase inhibitor] to treat children
as young as 2 weeks old who have shown symptoms of flu. The drug was
previously approved to treat adults and children one year and older.
The dose for children under one year old must be based on their exact

Flu is extremely unpredictable. “You never know when the peak will
occur or how big the peak will be,” Bresee said. “If you’ve seen one
flu year, it’s just one flu year.” Last winter’s flu season
[2011-2012], for example, set a new record for the lowest and shortest
peak of influenza-like illness. The season began late and was mild
compared with most previous seasons. The last time a regular flu
season started this early was the winter of 2003-04, which proved to
be one of the deadliest seasons in the past 35 years, with more than
48 000 deaths. The dominant type of flu back then was the same one
seen this year [2012]. But experts said there is a critical difference
between then and now: In 2003-04, the vaccine was poorly matched to
the predominant flu strain. Also, health officials said more vaccine
is available now, and vaccination rates have risen for the general
public and for key groups such as children, pregnant women and
health-care workers.

About 112 million Americans had been vaccinated by the end of November
2012, the CDC said. Manufacturers were expecting to produce about 135
million total doses this year [2012]. Flu vaccinations are recommended
for everyone 6 months or older. On average, about 25 000 Americans die
each flu season, according to the CDC.

Flu usually peaks in midwinter. Symptoms can include fever, cough,
runny nose, head and body aches, and fatigue. Some people also suffer
vomiting and diarrhea, and some develop pneumonia or other severe
complications. A strain of swine flu that hit in 2009 caused a wave of
cases in the spring and then again in the early fall. But that was
considered a unique type of flu, distinct from the conventional
strains that circulate every year, experts said.

[Byline: Jacquelyn Martin]

– —
Communicated by:
ProMED-mail <[email protected]>

[There are distinctive differences in the characteristics of the early
phase of the northern hemisphere winter influenza epidemic between
North America and the European Region. In particular. Influenza
A/(H3N2) virus is not the predominant virus in the European Region.

According to the current EuroFlu – Weekly Electronic Bulletin (Week 5:
17/12/2012-23/12/2012, 28 Dec 2012, Issue N 468
<>): “Influenza
activity is slowly increasing with more countries in different parts
of the [European] Region reporting sporadic co-circulation of
influenza A(H1N1)pdm09, A(H3N2) and type B viruses. This week, the
reporting of influenza surveillance data is incomplete due to the
Christmas holidays. This is reflected in the lower number of tests
performed. However, the percentage of influenza-positive samples from
both sentinel and non-sentinel sources are similar to last week. The
number of reported hospitalisations due to severe acute respiratory
infection (SARI) remains similar to that seen in the previous several
weeks: One influenza detection was reported (influenza B). The number
of specimens testing positive for influenza decreased together with
the number of samples tested due to the relatively low reporting rate
by the countries in the western part of the region caused by holidays
this week. Overall, a total of 386 specimens tested positive for
influenza in week 51/2012: 275 were type A, and 111 were type B. Of
the influenza A viruses, 74 were subtyped: 38 as A(H3N2) and 41 as
A(H1N1)pdm09.” – Mod.CP

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Concierge Medicine will get Massive Boost from Obamacare

Sunday, December 23, 2012 // Uncategorized

Concierge Medicine Will Get Massive Boost from Obamacare

Posted December 22, 2012
by Dike Drummond MD

Concierge Medicine will get Massive Boost from Obamacare

The shortage of physicians caused by the implementation of the Affordable Care Act in the next five years will drive a massive increase in the popularity of Concierge Medicine in the US.

As the typical healthcare organization adapts to the coming tidal wave of newly insured patients it will become very difficult for you to see your doctor when you are ill, impossible to see them for routine care and make the typical experience of getting a checkup feel like being dropped into a “patient mill”.

5 years from now, If you want to have a personal physician see you for all your healthcare needs, you will need to pay for the privilege.

One popular way to do this is “concierge medicine” where you pay a monthly or annual premium directly to your doctor and, in return, they become your own personal physician, taking direct responsibility for your healthcare needs. The good news is that concierge medicine is no longer a privilege of the rich. Premiums are becoming much more affordable – as low as $200/year – and if you enjoy seeing “my doctor” and not being rushed, you will feel the additional money for a concierge medicine doctor is well spent.

Concierge medicine popularity will also be driven by the primary care doctors themselves. Those who want to continue to have a personal relationship with their patients will find it very difficult to be satisfied with the typical high volume practice.

Why Concierge Medicine and why now?

The Association of American Medical Colleges estimates that there will be a shortage of 91,500 doctors by 2020 as the Obamacare insurance coverage provisions are implemented and 30 million Americans become eligible for health insurance coverage.

This tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame. There is no hope whatsoever to cover the shortfall with newly minted US Residency graduates … none.

The Fork in the Roadconcierge medicine and the obamacare physician shortage

How will healthcare markets respond – especially with regards to primary care? As the shortage of primary care providers worsens it will literally create a fork in the road for patients and doctors, driving the structure of their practices into two completely different tracks.

– Each is a distinct and logical response to the massive patient overload
– The two models produce dramatically different experiences for both the patients and doctors
– And each will expose gaping holes in a physician’s medical education that must be addressed.

Track 1)
Volume Driven: Doctor as apex of a care pyramid


In the more traditional practice structure, the physician will be come the leader of a care team supervising a number of Nurse Practitioners and Physician Assistants who provide the majority of the hands-on care. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day. The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.

This model is invisibly driven by a financial reality – the very high overhead of the practice. The only solution for these groups will be to maximize patient volume. All the front line providers will see 20-30 patients a day, most likely with 15 minute time slots for each visit. It will look and feel like a “patient mill” with everyone doing their best to maximize patient satisfaction and outcomes under extreme time pressure.

As a patient in this model you will only see your doctor on rare occasion and only when you are very ill. Your primary relationship with be with a P.A. or N.P. This may come as a bit of a shock if you are used to seeing “my doctor” whenever you are sick or need a routine checkup.

In 5 years we will learn to accept this as the “normal practice of medicine” in America. All corporate forces in healthcare are leading in this direction at the moment and it seems clear that volume driven care will become the new normal for the majority of patients and medical practices.

For the physician, the challenge of this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spend in leadership and management activities for which they are not prepared on graduation. Office team leadership training should be a popular CME topic in the years ahead.

Track 2)
Service Driven: Concierge medicine / direct care model

As the typical patient begins to notice they are only seen by a physician on rare occasion, a certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a substantial wave of new demand for concierge medicine services especially as premiums continue to fall and more concierge medicine practices are available.

The surplus of patients means a shortage of doctors. As the shortage worsens, a larger and larger segment of our population will become willing to pay to continue to see their doctor as they do today, especially if your alternative is the high volume patient mill practice I described above.

The huge popularity of the concierge medicine model will have another important driving force – the doctors. The office duties of the physician here are exactly the opposite of those in example #1 above. Here the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients. And the dramatically lower overhead of the concierge medicine model means they can make the same amount of income as the volume driven doctors without having to see all those patients or supervise a team of mid-level providers.

As a patient, you will continue to see your doctor whenever you are ill or in for routine care. The doctor will most likely be practicing solo in a small office and will have much more time available for your visit.

As a physician, the challenge of this model is the absence of business training – and specifically marketing training – in most medical education programs. The concierge medicine model is inherently entrepreneurial and will always involve a fairly sophisticated marketing program to be successful. For the first time the doctor must enroll their own patients who pay with their own money for this direct relationship. Acquiring these skills is not an insurmountable obstacle and I have yet to meet a newly board certified MD who understands the essentials of marketing.

What’s a patient to do?

If you would like to continue to have direct access to your doctor in the years ahead, I encourage you to investigate concierge medicine services in your area and ask your current doctor if they have considered a concierge medicine practice. If you google “concierge medicine (your city here)”, you will most likely find a practice nearby. They would be happy to meet you and introduce you to the practice at no charge.

What’s a doctor to do?

If you are a primary care physician with 10 or more years of practice ahead of you, I suggest you look at the various concierge medicine business models and get ready to be met by the fork in the road.

Will you choose to lead a team or build your concierge medicine practice? If you are leaning in one direction or the other, I suggest you get started building your missing skill set – be that leadership or marketing. The wave of newly insured patients is coming.

PLEASE LEAVE A COMMENT with your thoughts on the concierge medicine fork in the road and which practice model you prefer.

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Lump Of Coal #2: Tamiflu Back Ordered

Saturday, December 22, 2012 // Uncategorized

Christmas lump of coal #1 is that the flu hit Texas early this year.  Today I found out from my local pharmacist, that he can’t get tamiflu, the most commonly used antiviral medication, because it is back ordered from the manufacturer.  The good news is that the strains of flu going around are represented in this years blend of flu vaccine.  Tamiflu is not terribly effective and is best reserved for the very old, very young and pregnant women.

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General Internists, An Endangered Species?

Tuesday, December 11, 2012 // Uncategorized

Sigh.  More bad news about residences choices. 

Even many residents in primary care training programs not planning to enter primary care

Most internal medicine residents, even those in primary care residencies, don’t plan to practice general internal medicine, a recent survey found.

U.S. internal medicine residents were surveyed about their career plans while taking the Internal Medicine In-Training Examination (IM-ITE). Data were gathered from more than 57,000 residents who responded to the survey in 2009-2011. About a third of the responses came from third-year residents. Results were published in the Dec. 5 Journal of the American Medical Association.

Overall, 21.5% of the residents reported plans to practice general internal medicine (GIM). Residents in primary care residency programs were more likely to choose GIM than those in categorical internal medicine residency programs (39.6% vs. 19.9%), but a subspecialty career was the most common plan for both groups (52.5% of primary care residents, 65.3% of categorical residents). Among primary care residents, there was a significant difference between the plans of U.S. medical school graduates and international medical graduates (IMGs). More than half (57.3%) of primary care IMGs were planning to subspecialize, compared to only 27.3% of U.S. grads.

The study also found that female residents were more likely than male residents to ever report a plan of a GIM career (26.7% vs. 17.3%) and to stick with that plan over the course of their training (62.4% of women reporting a GIM plan in their first year also reported one in their third year vs. 47.2% of men). The study showed that many residents change their mind about career plans, both for and against GIM, the authors noted.

This is the first study to find that even primary care residents are commonly opting for subspecialty careers, the authors added. Thus, expanding medical school enrollment or primary care residency slots might not significantly increase the supply of GIM physicians. Further investigation of the causes and potential solutions to IMG primary care residents’ lack of interest in GIM may be important, however, since they fill the majority of the residency slots in primary care training programs, the authors said.

An accompanying editorial noted that the field of hospital medicine is an additional contributor to the shortage of general internists in primary care; 9.3% of the third-year residents reported plans to be a hospitalist. The editorial called for protection and realignment of graduate medical education funding.

I would bet that a lack of role models may be a contributing problem.
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Electronic Medical Records, What Doctors Think

Thursday, December 6, 2012 // Uncategorized

Electronic Health Records Breed Digital Discontent For Some Docs

By Eric Whitney, Colorado Public Radio

Dec 04, 2012


This story is part of a reporting partnership that includes Colorado Public RadioNPR and Kaiser Health News.

Two years and $8.4 billion into the government’s effort to get doctors to take their practices digital, some unintended consequences are starting to emerge. One is a lot of unhappy doctors. In a big survey by Medscape this summer 38 percent of the doctors polled said they were unhappy with their electronic medical records system.

Source: Medscape EHR Report 2012

Dr. Mary Wilkerson is one of those doctors. Her small family practice in Denver made the leap to an electronic health record five years ago, with some pretty high expectations.

“We were told by sales people that we would make more money, because we’d be more efficient, and you’d be able to see more patients,” says Wilkerson. “We’d be able to bill faster, get the money in the bank at the push of a button. And none of that panned out.”

Instead, Wilkerson’s practice found that electronic records actually slowed things down, and the doctors could see fewer patients.

“Within six months of our purchase, one of the partners just did not like it at all, did not like dealing with the computer, and actually left the practice, and we’d hoped she’d contribute to the loan that we’d taken out” to pay for the electronic system, says Wilkerson.

Wilkerson’s problems with the system are a stark contrast to the experience of other doctors who have embraced electronic records and patients who have good reviews of them, too.

Marina Blake of Denver is one of those patients. Blake uses a lot of health care, and she likes that the specialists she sees can all call up the same health record that her primary care doctor uses. She can also call up her own record anytime.

“It does add definitely a layer of customer service to my experience that is really awesome,” says Blake, who belongs to a large health care system that uses electronic records.  “For me it’s part of being an educated consumer. If I have more information, then I can ask better questions.”

The federal government wants every patient to see the same benefits from electronic records Blake does. It’s offering doctors and hospitals up to $63,000 per physician to go digital. 

But Wilkerson’s practice didn’t get much government money, because payments to go digital are tied to seeing a lot of Medicare patients, which Wilkerson and her partners didn’t do. They took out a loan because it’s common for physicians to pay $10,000 or more each for digital records systems. So losing income from not being able to see as many patients was hard on Wilkerson’s practice. The expense and the hassle was part of the reason that she and her partners ultimately decided to sell their practice.

Source: Medscape EHR Report 2012

The American Academy of Family Physicians supports the switch to digital but acknowledges that it has been difficult for many doctors.

“Right now we’re in a transitional time. Transitional times are tough,” says Dr. Jeff Cain, president of AAFP.

Cain says electronic records improve care, and notes that Medicare will start cutting payments to doctors who haven’t gone digital starting in 2015. He’s somewhat critical of the government’s strategy.

“The challenge for the family doctor with the carrot-and-stick approach Medicare’s using is, the carrot’s kind of hard to get to,” says Cain.

For its part, Medicare is now worried that part of the digital efficiency it’s encouraging is also making it easier for doctors to generate bills, and charge it too much. Doctors say it should be no surprise that systems designed to catch things like medication errors are also catching missed opportunities to get paid.

That unanticipated argument over billing is playing out as federal payments begin to ramp down. They’re being offered until 2021, but the amount available gets smaller every year.

This story is part of a reporting partnership that includes Colorado Public RadioNPR and Kaiser Health News.

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Flu News

Wednesday, December 5, 2012 // Uncategorized

It’s shaping up to be a bad flu season.  First is the report from the CDC followed by a report on Tamiflu and the British Medical Journal



Situation Update: Summary of Weekly FluView

Key Flu Indicators

According to this week’s FluView, flu activity in the United States has increased substantially throughout the nation, most notably in the south central and southeast regions of the country.  People who have not already received a flu vaccine should do so now. This FluView update reports on influenza activity for November 18-24, 2012 of the 2012-2013 influenza season.

Below is a summary of these key indicators:

  • The proportion of visits to doctors for influenza-like illness (ILI) was at the national baseline. This is the earliest in the regular season that influenza activity has reached the national baseline level since the 2003-2004 season. This week, 5 U.S. regions reported ILI activity above region-specific baseline levels and 5 states (Alabama, Louisiana, Mississippi, Tennessee and Texas), experienced high ILI activity.  
  • Four states reported widespread influenza activity (Alaska, Mississippi, New York, and South Carolina). Regional influenza activity was reported by 7 states (Alabama, Idaho, Iowa, Maine, Massachusetts, North Carolina, and Ohio). Nineteen states reported local influenza activity. This is an increase from the 8 states that reported local influenza activity last week.
  • Data regarding influenza-associated hospitalizations for the 2012-2013 influenza season will be reported starting with the December 7, 2012 FluView.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Mortality Reporting System was below the epidemic threshold.
  • No influenza-related pediatric deaths were reported for November 18-24, 2012. Two influenza-associated pediatric deaths have been reported during the 2012-13 season. Nationally, the percentage of respiratory specimens testing positive for influenza viruses in the United States during the week of November 18-24 was 15.2%. This is an increase from last week and remains relatively elevated for this time of year. The regional percentage of respiratory specimens testing positive for influenza viruses ranged from 3.8% to 20.6%.
  • Both influenza A (H3N2 and 2009 H1N1) and influenza B viruses have been identified this season. During the week of November 18-24, 571 of the 812 influenza positive tests reported to CDC were influenza A and 241 were influenza B viruses. Among the 571 influenza A viruses identified that week, approximately 35% were H3 viruses and less than 1% were 2009 H1N1 viruses; 65% were not subtyped.
  • Since October 1, 2012, CDC has antigenically characterized 140 influenza viruses, including two 2009 influenza A (H1N1) viruses, 90 influenza A (H3N2) viruses and 48 influenza B viruses.
  • The 2009 influenza A (H1N1) viruses were characterized as A/California/7/2009-like. This is the influenza A (H1N1) component of the Northern Hemisphere vaccine for the 2012-2013 season.
  • All 90 of the influenza A (H3N2) viruses were characterized as A/Victoria/361/2011-like. This is the influenza A (H3N2) component of the Northern Hemisphere influenza vaccine for the 2012-2013 season.
  • Approximately 71% of the 48 influenza B viruses belonged to the B/Yamagata lineage of viruses, and were characterized as B/Wisconsin/1/2010-like, the influenza B component for the 2012-2013 Northern Hemisphere influenza vaccine.
  • The remaining 29% of the tested influenza B viruses belonged to the B/Victoria lineage of viruses.
  • Since October 1, 2012, CDC has tested two 2009 influenza A (H1N1), 122 influenza A (H3N2), and 81 influenza B virus isolates for resistance to neuraminidase inhibitors this season. Each of the viruses showed susceptibility to the antiviral drugs oseltamivir and zanamivir. High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses. (Adamantanes are not effective against influenza B viruses.)

FluView is available – and past issues are archived – on the CDC website.


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British medical journal slams Roche on Tamiflu

By MARIA CHENG | Associated Press – Mon, Nov 12, 2012

  • FILE - In this April 28, 2009 file photo packages of the medicine Tamiflu by Swiss pharmaceutical company Roche are seen in Stuttgart, southern Germany. A leading British medical journal is asking the drug maker Roche to release all its data on Tamiflu, claiming there is no evidence the drug can actually stop the flu. The drug has been stockpiled by dozens of governments worldwide in case of a global flu outbreak and was widely used during the 2009 swine flu pandemic. On Monday Nov. 12, 2012, one of the researchers linked to the BMJ called for European governments to sue Roche. (AP Photo/Thomas Kienzle, File)

    Enlarge PhotoAssociated Press/Thomas Kienzle, File – FILE – In this April 28, 2009 file photo packages of the medicine Tamiflu by Swiss pharmaceutical company Roche are seen in Stuttgart, southern Germany. A leading British …more  medical journal is asking the drug maker Roche to release all its data on Tamiflu, claiming there is no evidence the drug can actually stop the flu. The drug has been stockpiled by dozens of governments worldwide in case of a global flu outbreak and was widely used during the 2009 swine flu pandemic. On Monday Nov. 12, 2012, one of the researchers linked to the BMJ called for European governments to sue Roche. (AP Photo/Thomas Kienzle, File)  less 

Related Content

LONDON (AP) — A leading British medical journal is asking the drug maker Roche to release all its data on Tamiflu, claiming there is no evidence the drug can actually stop the flu.

The drug has been stockpiled by dozens of governments worldwide in case of a global flu outbreak and was widely used during the 2009 swine flu pandemic.

On Monday, one of the researchers linked to the BMJ journal called for European governments to sue Roche.

“I suggest we boycott Roche’s products until they publish missing Tamiflu data,” wrote Peter Gotzsche, leader of the Nordic Cochrane Centre in Copenhagen. He said governments should take legal action against Roche to get the money back that was “needlessly” spent on stockpiling Tamiflu.

Last year, Tamiflu was included in a list of “essential medicines” by the World Health Organization, a list that often prompts governments or donor agencies to buy the drug.

Tamiflu is used to treat both seasonal flu and new flu viruses like bird flu or swine flu. WHO spokesman Gregory Hartl said the agency had enough proof to warrant its use for unusual influenza viruses, like bird flu.

“We do have substantive evidence it can stop or hinder progression to severe disease like pneumonia,” he said.

In the U.S., the Centers for Disease Control and Prevention recommends Tamiflu as one of two medications for treating regular flu. The other is GlaxoSmithKline’s Relenza. The CDC says such antivirals can shorten the duration of symptoms and reduce the risk of complications and hospitalization.

In 2009, the BMJ and researchers at the Nordic Cochrane Centre asked Roche to make all its Tamiflu data available. At the time, Cochrane Centre scientists were commissioned by Britain to evaluate flu drugs. They found no proof that Tamiflu reduced the number of complications in people with influenza.

“Despite a public promise to release (internal company reports) for each (Tamiflu) trial…Roche has stonewalled,” BMJ editor Fiona Godlee wrote in an editorial last month.

In a statement, Roche said it had complied with all legal requirements on publishing data and provided Gotzsche and his colleagues with 3,200 pages of information to answer their questions.

“Roche has made full clinical study data … available to national health authorities according to their various requirements, so they can conduct their own analyses,” the company said.

Roche says it doesn’t usually release patient-level data available due to legal or confidentiality constraints. It said it did not provide the requested data to the scientists because they refused to sign a confidentiality agreement.

Roche is also being investigated by the European Medicines Agency for not properly reporting side effects, including possible deaths, for 19 drugs including Tamiflu that were used in about 80,000 patients in the U.S.



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The Latest in the Running Controversy: Is Too Much Running Bad for You?

Sunday, December 2, 2012 // Uncategorized

Maybe.  Too much of other good things can definitely be harmful.  This is the latest on the controversy on running from the WSJ.  This controversy has been around for a long time.

The Wall Street Journal

  • November 27, 2012, 8:02 p.m. ET

One Running Shoe in the Grave

New Studies on Older Endurance Athletes Suggest the Fittest Reap Few Health Benefits




[image] Associated PressAthletes compete in the World Triathlon Grand Final in Auckland, New Zealand, on Oct. 21.

In a five-kilometer race Thanksgiving morning, Ralph Foiles finished first in his age group, earning the 56-year-old Kansan a winner’s medal.

Or was it a booby prize?

A fast-emerging body of scientific evidence points to a conclusion that’s unsettling, to say the least, for a lot of older athletes: Running can take a toll on the heart that essentially eliminates the benefits of exercise.

“Running too fast, too far and for too many years may speed one’s progress toward the finish line of life,” concludes an editorial to be published next month in the British journal Heart.

Until recently, the cardiac risk of exercise was measured almost exclusively by the incidence of deaths during races. For marathoners, that rate was one in 100,000—a number that didn’t exactly strike fear. Moreover, data showed that runners generally enjoyed enormous longevity benefits over nonrunners.

What the new research suggests is that the benefits of running may come to a hard stop later in life. In a study involving 52,600 people followed for three decades, the runners in the group had a 19% lower death rate than nonrunners, according to the Heart editorial. But among the running cohort, those who ran a lot—more than 20 to 25 miles a week—lost that mortality advantage.

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Resisting baked goods is a special kind of torture for the 58-year-old founder and co-chief executive of Panera Bread. But Ron Shaich has adopted a workout that lets him enjoy his carbs in moderation. Melanie West has details on Lunch Break. Photo: Matthew Healey for The Wall Street Journal.

A growing number of older Americans are exploring martial arts such as tae kwon do and judo as a way to stay physically and mentally fit. With its kicks, punches and take downs, they are finding the sport brings a number of health benefits as well as increased confidence and respect.


Meanwhile, according to the Heart editorial, another large study found no mortality benefit for those who ran faster than 8 miles per hour, while those who ran slower reaped significant mortality benefits.

Those two studies—presented at recent medical conferences—follow the publication in recent months and years of several other articles finding cardiac abnormalities in extreme athletes, including coronary artery calcification of a degree typically found in the utterly sedentary.

Joseph BattagliaMeghan Newcomer is a 32-year-old professional triathlete who has passed out during several races in recent years.

Opinion is nearly unanimous among cardiologists that endurance athletics significantly increases the risk of atrial fibrillation, an arrhythmia that is estimated to be the cause of one third of all strokes. “Chronic extreme exercise appears to cause excessive ‘wear-and-tear’ on the heart,” the editorial says.

Not everyone is lining up behind the new data. “The guys advancing the hypothesis that you can get too much exercise are manipulating the data,” said Paul Thompson, a former elite marathoner and nationally renowned sports cardiologist at Hartford Hospital. “They have an agenda.”

Sports cardiologist James O’Keefe, an author of the Heart paper, counters that Dr. Thompson is an exercise addict. “He, like many chronic exercise addicts, is the one with an agenda,” said Dr. O’Keefe, a sports cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City. “My ‘agenda’ is my patients.”

Critics of the newer research say that the idea that running can harm the heart is based on research showing only an association—meaning that exercise may not be the cause of the problem. The note that in any large group of runners, high-mileage and high-speed athletes may be too few in number to be statistically significant.

Yet by all accounts, dosage is no less relevant to exercise than to any other medical treatment, and for years the endurance-athletics movement has prompted words of caution from none other than Kenneth Cooper, the Dallas physician widely credited with launching the aerobics movement nearly half a century ago. “If you are running more than 15 miles a week, you are doing it for some reason other than health,” said Dr. Cooper, adding that he suspects—without hard evidence—that extreme exercise can render a body more susceptible to cancer.

The most vocal proponent of cutting back for cardiac reasons is Dr. O’Keefe, a 56-year-old cardiologist and former elite athlete. From 1999 to 2004, he won outright the largest sprint distance triathlon in Kansas City, a testament not only to his athletic abilities but also to hours and hours of early- and late-hour training.

But a sense that this regimen was aging him prematurely, coupled with the mounting awareness of cardiac issues in extreme endurance athletes, prompted Dr. O’Keefe to slash his running to below 20 miles a week, never faster than eight minutes a mile.

Asked if he ever runs a five-kilometer race for time, he said, “Not for the past three years. After age 50, pushing too hard is probably not good for one’s heart or longevity.”

Meanwhile, Dr. O’Keefe’s fellow author on the upcoming Heart paper, Carl Lavie, continues racing at speeds slightly above what their editorial recommends. “I did a turkey day five-mile race in 38 minutes,” said Dr. Lavie, a cardiologist at the John Ochsner Heart and Vascular Institute in New Orleans. “I train slower than I race, and when I race I know the risks. That’s all we’re trying to do: Let people know the risks and make up their own minds.”

The conflict between pursuit of health and of athletic glory is particularly acute in Meghan Newcomer, a 32-year-old professional triathlete who in recent years passed out during several races, requiring acute medical attention and prompting her loved ones to ask her to slow down or retire. She has a promising medical career, after all: Why not quit competing?

Instead, after undergoing in-depth study at a Connecticut sports-medical clinic, she was told to triple her intake of sodium during races. Yet she was also told to slow down, advice that helped her this summer complete—without passing out—her first Ironman-distance triathlon.

The idea that serial marathoners may earn no cardiac advantage over couch potatoes will surely amuse serial viewers of “Seinfeld” reruns. But don’t expect the running boom to grind to a halt. Optimal health isn’t necessarily the Holy Grail, even for aging athletes.

“Even if I knew for sure that running fast had an element of risk, I don’t know that I would back down,” said Foiles, the 56-year-old runner who lives in a Kansas City suburb. “To finish at the front of my age group, yeah, that’s an inspiration.”

A version of this article appeared November 27, 2012, on page D6 in the U.S. edition of The Wall Street Journal, with the headline: One Running Shoe in the Grave.


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