Author: VWheelock

296. Another Medical Martyr, Dr. Waney Squier (Part One. How it all began)

Background Readers of this website with be all too familiar with the attacks on the scientific competence and reputation of Professor Tim Noakes in South Africa (1). Recently, I listened to a radio broadcast about Shaken Baby Syndrome (SBS), also referred to as abusive head trauma (AHT) or non-accidental head injury (NAHI) that has a number of striking parallels. This encouraged me to do some digging and as a result I have written this series of blogs. When a baby dies with injuries to the brain the question, the possibility arises that this may have been deliberately caused by a parent or guardian abusing the child by violent shaking. Alternatively it may have been due to a disease or an accidental fall. Obviously it is crucial to reach the correct decision on what happened and why. A wrong conclusion can result in guilty parties not being punished and even worse innocent people being convicted. There is no doubt that it is difficult to reach the right decision. When there is a prosecution, the courts are critically dependent on the input of expert witnesses. In the UK, Dr. Waney Squier, a noted neuropathologist, has acted in this capacity for many years. This is the story. In a trial of Lorraine Harris during 2000, Dr. Squier acted as a prosecution witness and testified that Harris’s son Patrick died as a result...

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295. Vitamin D: Are We Getting Enough?

Rheumatoid arthritis A recent paper reports on research conducted at the University of Birmingham has discovered that maintaining sufficient vitamin D levels may help to prevent the onset of inflammatory diseases like rheumatoid arthritis (1). The scientific paper is available here (2). It was also found that although Vitamin D can help to prevent the onset of inflammation, it is less effective once inflammatory disease is established because diseases such as rheumatoid arthritis leads to vitamin D insensitivity. Because Vitamin D is a potent modulator of the immune system, it can suppress inflammation in autoimmune diseases such as rheumatoid arthritis. Patients with rheumatoid arthritis are frequently vitamin D deficient and may receive vitamin D supplementation. When clinicians are using Vitamin D to treat rheumatoid arthritis, they may need to prescribe much higher doses than currently employed. This is just one more example, which indicates that relatively high doses may be needed to ensure that Vitamin D can function effectively. The official recommendations In the UK, the Scientific Advisory Committee on Nutrition (SACN) produced a report entitled “Vitamin D and Health” that was released in July 2016 (3). Prior to this report the recommendations were based on the prevention of rickets in children and osteomalacia in adults. A dietary intake of vitamin D was not considered necessary for individuals with adequate exposure to sunlight. For those considered at risk of...

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294. Drugs for Blood Pressure: Be Very Careful

Systolic Blood Pressure Intervention Trial (SPRINT) Two years ago, the results of SPRINT were announced in the New England Journal of Medicine (NEJM) (1). In this trial, the blood pressure (BP) medication is adjusted to achieve a target systolic BP of 120 millimeters of mercury (mm Hg). The investigation continued for 8 years and the total cost was $157 Million. In the announcement by National Heart, Lung and Blood Institute (NHLBI), the funding body it was claimed that the treatment resulted in reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third. The risk of death was reduced by almost a quarter, as compared to the target systolic pressure of 140 mm Hg (2). According to Dr Lawrence Fine, Chief of the Clinical Applications and Prevention Branch at NHLBI: “Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall.” It was concluded that the results of the SPRINT study reaffirm the critical importance of blood pressure control as the best approach to reduce complications of high blood pressure like heart attacks and strokes (3). Doubts emerge However within days of the publications, there were criticisms levelled at the conduct of the trial and the implications drawn from the results. In an article...

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293. Treating Type 2 Diabetes (T2D)

I have just noticed a paper, which was designed to compare an intensive lifestyle intervention with standard care for the treatment of T2D. A secondary objective was to study the impact on the amount of medication used for, glucose-lowering. Unfortunately the paper are behind a paywall so I have not been able to access the finer details but the protocols are available in a previous paper (2) and the key results in the abstract are sufficient for me to draw conclusions. The procedures The trial was conducted in Copenhagen with 2 groups of patients that have been diagnosed with T2D.  It lasted for 12 months. One is simply given the standard treatment for diabetics in Denmark. But the other was encouraged to adopt an intensive lifestyle based on the following components: Increased levels of structured and supervised training Antidiabetic diet Increased levels of basal physical activity Increased sleep duration Self-monitoring of behaviours related to components 1–4 as well as perceived stress level, mood and motivation Diabetes management education and networking. Physical activity The physical activity expected is unbelievable. This consisted of four aerobic training sessions per week of 45–60?minute duration. On top of this there were two more sessions made up of aerobics for 30-35 minutes plus another 30 minutes of resistance training. The training was structured with supervision throughout the period. The participants worked in groups of 4-8...

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292. The Vioxx Scandal

In 1999, the pharmaceutical company Merck introduced the drug Vioxx (Rofecoxib) to be used as an anti-inflammatory treatment for pain associated with osteoarthritis. It was claimed to be effective and safer than other treatments already available. Subsequently it was found to increase the risks and deaths due to cardiovascular disease and was withdrawn from the market. Harlan Krumholtz and colleagues were involved in the legislation that resulted, which gave them access to company documents that provided valuable insight into the relevant background. Their conclusions were summarised in a paper published in the BMJ (1). The Merck studies Studies conducted during 1996/7 raised the possibility that the drug increased the risk of thrombus formation. Despite this the company failed to explore this aspect in greater depth. In fact it cobbled together results from a range of limited studies to prepare marketing material used to promote the cardiovascular safety of the drug to the medical profession. This “cardiovascular card” was criticised by US Congressman Henry Waxman because it falsely minimised the cardiovascular risks and had never been approved by the FDA. In January 1999, the VIGOR study was started. This was designed to show that Vioxx would have fewer gastrointestinal side effects than a competitor drug, naproxen, for the treatment of rheumatoid arthritis. However it was clear that the study was initiated without any proper procedures for collecting information on cardiovascular...

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