Study adds weight to case against cholesterol drug Zetia

 
Bad news continues to buffet the once-blockbuster cholesterol drug ezetimibe, which is sold under the brand name Zetia. Backing up research released last year, a new study has found that ezetimibe does not reduce fatty build-ups in the arteries, despite lowering levels of "bad" (LDL) cholesterol in the blood. On the other hand, one of the oldest treatments for high cholesterol—the B vitamin niacin—seems to help on both counts, say the researchers.

The study included 363 people with heart disease, or a high risk of the disease, who had been taking drugs called statins for several years to lower their cholesterol. Statins are the usual go-to drug when changes in diet and exercise don't reduce a person's cholesterol enough. But sometimes even statins fall short and people need additional treatment. Ezetimibe was approved by the FDA as a supplemental treatment, and for occasional use on its own, in 2002. Besides Zetia, you can also get a pill called Vytorin that combines ezetimibe with a statin (the earlier research looked at this combined form).

In the new study, half the people took ezetimibe and half took an extended-release version of niacin, in addition to their statin. All had regular ultrasound scans to check the narrowness of the arteries in their necks. The level of build-up in these blood vessels can help predict a person's risk of having a heart attack or stroke.

Tai Chi for the arthritic knee

I have many wonderful memories of my grandmother, but one of the most vivid, strangely enough, is of her attempting to get out of her chair. She'd shift to the front of the cushion, brace herself against the armrests, and slowly rise to almost standing—only to plop back down into the cushion, usually with an exasperated chuckle. She had a good sense of humor about her knee problems, but they did cause her frequent pain and were more than just a nuisance as she tried to get on with her day.

Like millions of older Americans, my grandmother had osteoarthritis in her knee. This joint disease can cause pain, stiffness, and limited movement, making even simple tasks (such as getting up from a chair) difficult. Many people rely on painkillers to cope with their symptoms. Exercise and physical therapy can also help, although the improvements are often modest. However, a new study suggests that Tai Chi is one type of exercise that can be particularly beneficial for people with this chronic condition.

The study compared two groups of people age 55 or older who had osteoarthritis of the knee. One group met twice weekly for Tai Chi classes. The other met twice weekly for general wellness instruction and stretching exercises. Both groups were asked to practice their exercises at home for at least 20 minutes a day.

Misuse of antipsychotics found in Illinois nursing homes

Elderly people in nursing homes across Illinois are being giving antipsychotic drugs they don’t need, sometimes with deadly consequences, according to a Chicago Tribune article.

These drugs, which include quetiapine (Seroquel), risperidone (Risperdal), haloperidol (Haldol) and others, can help improve symptoms of schizophrenia and other mental disorders, but they can also cause dangerous side effects, including abnormal limb and body movements, seizures, and rapid heart beat. So it’s essential to use them with caution.

The Tribune investigation, which is based on state and federal inspection reports, found that since 2001, there have been 1,200 violations at Illinois nursing homes involving antipsychotic drugs. In total, 2,900 patients were affected, including 12 who died due to misuse of antipsychotics.

In more than 600 instances, nursing homes had been cited for violating regulations because they gave residents antipsychotic medicines without their permission. More than 200 residents fell after being given antipsychotic drugs, resulting in several deaths and broken hips.

Pressing the White House on health reform: Medicare

Polls show that older Americans are more dubious about health reform than younger people. That’s understandable in a way, because they’re the only group that already has guaranteed health care and thus has less to gain from reform. Meanwhile, the bills under consideration propose cutting hundreds of billions of Medicare dollars over the next decade to help pay for reform. No wonder seniors are worried.

 I asked Nancy-Ann DeParle, director of the White House Office of Health Reform, to address the concerns of Medicare beneficiaries.

"There’s nothing in these bills that is cutting Medicare benefits," she said. "Beneficiaries will still have access to their doctors and the same benefits they have now. But … there are a number of ways in which we can make Medicare more efficient and actually strengthen it, make it more solvent."

For example, she said that right now, Medicare pays hospitals tens of billions of dollars extra to cover the care they give to uninsured patients who can’t pay their bills. "As the uninsured get covered, we can lower the payments," she said.

Further savings will come from health technology that makes doctors and hospitals more efficient, and from going after Medicare fraud more aggressively, she said.

I asked her specifically about Medicare Advantage, the private Medicare plans that now insure about one in four Medicare beneficiaries and are slated for significant cuts in the various reform bills.

Showerheads can breed bacteria

That’s right. One of the last pillars of everyday life that possessed some ability to give you pleasure and relaxation—a shower!—could be less than the hygienic endeavor you’d thought it was.

A recent study suggests that the slimy nooks and crannies on your showerhead can harbor bacteria, including a relative of the organism that causes tuberculosis. And when you turn on the shower, the pathogens combine with the water droplets, allowing you to breathe it all in deeply. (Those bacteria can also lurk wherever there is continuous moisture and heat, such as a humidifier that hasn’t been cleaned or a food preparation area.)

Most at risk are those with compromised immune systems, including pregnant women, the elderly, or those with cystic fibrosis or AIDS.

Those at risk, or those who would rather not worry, can let the shower run for a minute or two with the curtain open to dilute the concentration.

For more details about the study, see our Home & Garden blog.

—Artemis DiBenedetto, Web associate editor

For more details about the study, see our Home & Garden blog.

How to catch the flu and how not to—surgical masks may be helpful

Hate it when somebody coughs right into your face and eyes? You're not just germ-phobic, that may be the most likely way to transmit influenza, according to a newly published study.

Researchers from UC-Berkley’s School of Public Health and the University of Illinois at Chicago’s School of Public Health concluded that close contact spraying of respiratory droplets with the influenza virus carried the greatest risk of infection, followed by hand contact with contaminated surfaces, and inhaling particles carrying the virus. The study was published in Risk Analysis: An International Journal published by the nonprofit Society for Risk Analysis, and used mathematical modeling to examine the theoretical risk of catching an influenza A virus—a type of influenza virus that includes the new H1N1 and several seasonal strains—through various types of exposures when a healthy person is caring for someone bed-ridden with the flu.

While these findings are theoretical, meaning they aren’t based on observations of actual people who caught the flu, they do give an idea of the best ways to prevent the flu. That starts with the flu vaccines, which should prevent your body from actually becoming infected. But evidence shows that influenza vaccines aren’t 100 percent effective, so good hand hygiene, covering coughs and sneezes, and avoiding close contact with sick people are crucial—even if you’ve been vaccinated.

Buzzword: The Hatch-Waxman Act

What does it mean? The Hatch-Waxman Act (formally known as The Drug Price Competition and Patent Term Restoration Act) first passed 25 years ago in 1984 helped make inexpensive generic drugs available to consumers. This law streamlined the process by which generic drug manufacturers could apply for Food and Drug Administration approval of their drugs once the patent on a brand-name medicine expired. Under this law, generic manufacturers can forego expensive clinical trials and instead gain FDA approval based on less costly studies that show their drugs are equivalent to brand-name medicines. This cut the expense of bringing a generic drug to market, which lowered the cost of these medicines for consumers. Generic drugs now comprise more than 60 percent of prescriptions filled—up from 19 percent in 1984, when this law was first enacted. (Learn 10 more ways to cut your drug costs.)

Why the buzz? Now 25-years old, the Hatch-Waxman Act has helped consumers save money even while health-care costs have generally soared. The Act provides generics that are just as safe and effective as brand-name drugs, but at a far lower price—often prices up to 70 percent or less of the brand-names. However, this law has also been used by brand-name drug makers to block generic drugs from becoming available to consumers. Brand-name drug makers have used provisions of the Hatch-Waxman Act to extend their patent that delay generic drugs from entering the market. In addition, brand-name drug makers have made deals with generic manufacturers where the generic firm keeps its drug off the market in exchange for payments from the brand-name firm. Both drug manufacturers benefit from these arrangements, but consumers lose out. (See best drugs for less for related information.)

Another emerging issue that is currently being debated in Congress is that the Hatch-Waxman Act does not provide for an FDA approval process for generic versions of biologics. These branded medicines are important therapies that are used to treat certain cancers, multiple sclerosis and other serious diseases but they can cost more than $100,000. The availability of generic biologics could dramatically reduce prices and save consumers significant amounts of money. Congress is currently considering legislation that would pave the way for FDA approval of generic biologics, or biosimilars, but so far, the issue remains unresolved.

7 ways to fewer wrinkles

Some people are born lucky—but for the rest of us wrinkles are a natural part of aging. And defying nature can mean trying out a number of eye creams, overnight serums, collagen-based injectables, and even some pretty interesting "facial toning" devices. While any one or combination of these products may work for you, our sister publication, ShopSmart, has some simple, do-it-yourself ways to prevent those fine lines from getting deeper:

1. Use a facial moisturizer with an SPF of at least 30 to limit the sun’s damage every day, not just when you’re at the beach.
2. Shield your face with a hat and sunglasses when you’re outdoors, particularly on sunny days.
3. Avoid tanning beds. Those ultraviolet rays can be even more intense than the sun’s and can increase your risk of skin cancer.
4. Don’t smoke. Tobacco ranks second only to sunlight in its dire effects on skin.
5. Try not to rub your eyes. Treat hay fever so you’re less itchy and not tempted to rub.
6. Sleep on your back. Mashing your face into a pillow can cause lines to form over time.
7. Get an annual eye exam. If you can’t see clearly, you’re likely to squint, which can create wrinkles.

—Ginger Skinner

Q&A: Can supplements fight macular degeneration?

Can antioxidant supplements for the eyes fight macular degeneration? —D.C., Bellport, N.Y.

Yes, if you already have the potentially blinding condition but it’s not too advanced. In a study of 4,757 people, those with moderate macular degeneration who took a daily antioxidant eye supplement (Ocuvite PreserVision and others) cut the risk of further retinal damage by 25 percent. But talk with your ophthalmologist first, since high doses of some antioxidants in the pills have been linked to health risks: beta-carotene with lung cancer in smokers, for example, and vitamin E with heart failure in people with diabetes.

Do coughs and colds make Alzheimer's worse?

Coughs and sneezes spread diseases, runs the old slogan, and according to new research, people with Alzheimer's disease who catch a cold could face more severe consequences than just a sniffle. It seems that infections could speed the decline in memory that happens with Alzheimer's.

The theory is that inflammation in the body plays a part in causing Alzheimer's. Inflammation is the body's response to illness or injury, so infections, or even bruises, could worsen the symptoms of Alzheimer's.

In the study, researchers measured levels of a chemical called TNF-alpha in 275 people with Alzheimer's. TNF-alpha is a chemical that helps cause inflammation in the body. Six months later, people with high levels of this chemical tended to score slightly worse in memory tests than people with lower levels. However, the effect was slight: small enough that you might not notice a difference in day-to-day life.

Uninsured and not 65 yet? Here's how health-care reform would help

There’s never a good time to be uninsured, but losing your coverage after age 55 can be a real disaster because by that age, a lot of people have developed some kind of pre-existing condition that makes them terrible risks in the eyes of health insurance companies.

Case in point: Rick Cristo, 63, of Scottsdale, Ariz. Here’s what he wrote recently in a comment on one of our blogs:

I have been on Cobra for 16 months and my coverage expires in October. I have tried to qualify for a private policy but have been turned down because I had Prostate Cancer in January 2008 and had it removed surgically and have had no signs of cancer since. I am 63 years old my wife is 53 years old and we can't get health insurance; do I have any options?

Cristo lost his job as a mortgage broker during the housing market collapse and neither he nor his wife has been able to land a job with health coverage since. He’d be happy to keep his COBRA plan, even though it costs more than $900 a month, because it’s comprehensive and took good care of him during his prostate cancer treatment. But he can’t. The existing COBRA law says his coverage runs out after 18 months, no exceptions.

Keep pedaling for healthy knees

I live half-way up a hill. It’s a lovely spot, but it does mean whenever I take my bicycle out for a spin, I’m going to find myself pedaling hard uphill, either on my way out or on my way back.

Instead of grumbling about the strain on my legs, next time I’ll be smugly reminding myself that I could be staving off knee osteoarthritis in years to come.

A new study suggests that women with stronger quadriceps (the muscle at the front of the thigh) are less likely to get painful knee arthritis.

Previous studies have suggested a connection between muscle strength and arthritis, but it’s been hard to prove. As people with arthritis tend to get less exercise, their muscles tend to get weaker. Weak muscles could be a consequence of arthritis, not a cause.

But this latest study started by measuring the strength of people’s leg muscles when they didn’t have arthritis, and followed them up to see whether they got it or not. Although the study isn’t conclusive for men, for women it does suggest that the strength in your quadriceps is protective.

Most seniors unaware how meds can impair their driving

I shudder to think how long my grandmother tooled around the country roads in her 1963 Cutlass Supreme. She finally gave up her keys (with my mother's strong urging) after noting that the road and approaching cars sometimes appeared to rise in the air. Up until then, none of us had realized just how bad her vision had become, and everyone (no doubt her neighbors and their livestock included) was relieved when she finally moved to the passenger seat.

While my grandmother's visual lapses were a clear sign not to drive, many older Americans get behind the wheel each day unaware that they also have extra reason to be cautious. According to a new study*, many adults over 55 don't know that the medications they take have the potential to impair their driving ability

The researchers surveyed 630 drivers, aged 56 to 93, about their medications, medical conditions and driving habits. Although 3 out of 4 reported taking prescription or over-the-counter drugs that can cause drowsiness, dizziness, blurry vision, or other side effects that might affect their driving, only 27 percent were aware of these potential side effects, and only 17 percent had been warned about them by a doctor, pharmacist, or other health professional. Even more startling: The older people were, the more of these medications they took—and the less likely they were to know about these risks.

Health Reform AdWatch: New ads mislead or dizzy seniors

Few groups are more coveted in the battle over health reform than seniors. The beneficiaries of 40-plus years of Medicare, America’s older adults are living longer, fuller lives than ever before and are very active participants in the democratic process. And this week, they’re the targets of two opposing ad campaigns. One is from American Association of Retired Persons (AARP) and the other from the 60Plus Association, a group that positions itself as a “conservative alternative” to AARP. Their home page has a photo of Pat Boone; AARP’s has a photo of Woodstock. ‘Nuff said.

Patronizing seniors with misinformation

The ad from 60PlusAssocation, running on cable TV, is sixty seconds of dramatically deployed misinformation. “Seniors have sacrificed,” a voiceover intones, as photos of the Great Depression, the landing at Normandy, white-haired veterans, and Arlington Cemetery cross the screen. Patriotic music and  a flag waving in the breeze segue to sad Grandmas in wheelchairs waiting for MRIs that, one assumes, will never come. The images are beyond condescending, right down to the man strapped to an oxygen tank with a doctor peering ominously down at him, as if ready to move in for the kill.

The ad repeats the usual scary predictions voiced by opponents of health reform, such as the charge that reform will limit your choice of doctors, result in long waits for care, and leave “government, not doctors, deciding if older patients are worth the cost.” (Uh, no, health reform does NOT promote euthanasia). It’s true that President Obama and House Democrats want to trim $500 billion in spending from the Medicare budget over the next 10 years, but these cuts would affect mainly providers, not benefits. And the new legislation would also pump in several hundred billion dollars in new Medicare funds targeted toward improving primary care and closing the “doughnut hole” that’s made prescription drugs unaffordable for many seniors.

Do not-for-profit nursing homes provide better care?

The decision to move my grandmother to a nursing home was very difficult for my parents. After all, when my grandmother was a girl in "the old country" (her native Germany), families would care for their elders in their home. And my parents did in fact do this for several years. But eventually my grandmother's worsening dementia and health meant that she required more care than my parents could safely provide, and they decided a nursing home was the best option. But then they were faced with another difficult decision: Which nursing home would provide the best-quality care, and how might they determine this?

These are common questions, and not just among concerned family members. Researchers and policy makers are also keen to learn which nursing homes provide the best care—and why. One factor thought to influence care quality is what's called "profit status": whether a facility is a for-profit business or a not-for-profit venture. One school of thought holds that not-for-profit homes deliver better care because this is more central to their mission, and they do not need to divert financial resources to shareholders and taxes. But another view suggests that for-profit nursing homes actually provide superior and more efficient care because they feel added pressure to compete on price and quality.

Many studies have put these opposing theories to the test, and researchers have recently published a review that summarizes their results. Overall, they found that not-for-profit nursing homes deliver higher-quality care than for-profit facilities. (This echoes our own findings from an analysis in 2006.) In the new review, the researchers looked at 82 studies done from 1965 to 2003. Forty found better care at not-for-profit homes, while three studies gave the nod to for-profit facilities. The remaining 39 studies had mixed results.