AVOIDING ANTIDIABETIC DRUGS APART FROM METFORMIN FOR AS LONG AS POSSIBLE

A new review last week from Quebec Universities of insulin use in 69674 elderly diabetics is both limited in application, and instructive. We regularly see older patients who were started on insulin when they were first diagnosed diabetic because they were acutely ill, but who mostly should have been weaned off insulin fairly soon onto metformin etc, since even insulin is associated with higher mortality let alone complications. The topic is thoroughly discussed recently.

Since hypertensive and glycation damage is a common consequence of even the prediabetic metabolic syndrome, a  crucial issue is what we see in practice, that for the treatment of hypertension,  the triple combination of low-dose thiazide diuretic eg HCT 12.5mg combined with amiloride  1.25mg as eg amiloretic /coamilozide and with lowdose reserpine (rather than betablocker) has no risk of aggravating or causing diabetes. It is unsurpassed for the gentle normalization of most  mild to moderate hypertension- especially when combined in the overweight with metformin to tolerance  so as to virtually abolish the future risk of developing diabetes. This combination brings no serious  problems, unlike the betablockers or the now-heavily punted but troublesome  calcium channel and angiotensin blockers.

It is encouraging  to see confirmed that in these elderly Quebecois (even with only 71% on metformin; 29% on sulphonylurea  monotherapy – which like cortisone doubled the risk of needing insulin; 25% on thiazide and 30% on betablocker therapy, and 5740 on 16 or more drugs) –   the incidence of becoming dependent on insulin is only 1% a year over the 7years of this study – possibly less since

1. we have no idea how many of these patients were coached enough on avoiding sugars and reducing both cooked fats, salt, alcohol and fructose, and

2. it is  better to start early especially antidiabetic antioxidant antilipidemic antiatheroma  balanced minerals, vitamins B C D E K, and biologicals (including the likes of fish oil, metformin/galega, coQ10,  arginine, carnitine; appropriate parenteral balanced human HRT (estrogen, testosterone, progesterone) , and  relevant other herbs). All these combined (in just  two  blends) can in a first-world population  largely avoid both need for cortisone and  insulin therapy,  fattening, diabetes, vascular / renal disease, dementia, osteoporosis, blindness, and cancer ;

3 taking metformin to tolerance (which is bizarrely uncommon practice) is far better  before if necessary adding sulphonylureas/ glitazones/ insulin which promote fattening and other problems,  with little net benefit..

4. starting on  metformin preventatively ie  well before diabetes presents  can reduce the incidence of new diabetes, pancreatic burnout and cancer  by up to 80%.

Yet preventative metformin- with zero serious adverse effects  and halving of mortality in appropriate use- is still  irrationally vociferously  objected to. Is this  because of the Disease Industry’s driving force, to avoid prevention at all cost since only disease pays: effective prevention with natural supplements  like metformin and appropriate parenteral HRT would deplete surgeries and hospitals of serious chronic degenerative illnesses.

The BARI study showed clearly that by the time vascular disease presents in diabetics, surgery has no better outcome than medical therapy. All four major diabetes prevention programs (in China then USA then India then Greece) confirmed the major benefit (even against cancer) of adding metformin early if the patient cannot implement permanent effective diet and exercise.

So why are “Authorities” still not mandating  preventative metformin in the resistant overweight at all ages? Why are those who should know better still  attacking  preventative physicians for practicing evidence-based medicine ie using appropriate metformin in a life-threatening situation- progressive or persistent overweight ie BMI above 25kg/sqm?

One hopes that this Quebec analysis pushes authorities to enforce that metformin built up slowly from eg 250mg/d  to tolerance -ideally with blood level control-  is the only firstline chronic drug   therapy of type 2 diabetes, even where the new patient has also to be temporarily stabilized with  insulin.

ndb

editorial: COMPLEMENTARY, HOMEOPATHIC MEDICINE APPROVED IN SWITZERLAND

editorial comment on `HOMEOPATHIC BASICS (June ’09)   Dr. Ron Beare ND., DHomMed, South Africa below:

On May 17, 2009, in a unique referendum “ the people of Switzerland voted by a two-thirds majority  to force Parliament to pass  a constitutional amendment that supports the use of complementary medicine (CAM), incorporating admission of doctors of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and Traditional Chinese Medicine (TCM) into obligatory health insurance; integration of complementary medicine into teaching and research; and safeguarding of proven remedies.”

This vote by the  notoriously conservative rightwing Swiss  is a stunning precedent for enforcement of the peoples’ sensible rights and wishes irrespective of the machinations of  politicians and Big Business, the inconvenient truth of  oligarchy disaster capitalism especially when it manipulates organized religion as extremist  “right wings” do everywhere from Islam to Baptist America to C of E Britain to Rome to  India, China, Japan and without exception in Africa. Especially in South Africa where the AK47-brandishing State President Rev Jacob Zuma- a habitual serial adulterer  (never mind polygamist) supported by acolytes swearing to kill for him – announces that he will rule until the Christ comes….

Phytotherapy, anthroposophical and TCM deal with foodstuffs, natural plant remedies- the origin and foundation of modern drugs. But what of homeopathy?

In 2005 the University of Berne published a major meta-analysis comparing homeopathy with allopathy (Hahneman’s reference term for conventional modern medicine)  in comparable chronic conditions including respiratory-allergy, musculoskeletal, neurological and gastrointestinal. They concluded that “Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. Discounting these biases, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions.”

But “110 homoeopathy trials and 110 matched conventional-medicine trials were analysed. 21 homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of higher quality. When the analysis was restricted to large trials of higher quality, the odds ratio was 0·88 (95% CI 0·65–1·19) for homoeopathy (eight trials) and 0·58 (0·39–0·85) for conventional medicine (six trials).”  This outcome statistically favours alopathic medicines and not homeopathy. .

But such analysis does not address the risk:benefit ie the adverse effects of allopathic drugs; it did note the small number of large trials of high quality.  So what this study largely raises is the power of placebo, belief ie autosuggestion and spontaneous resolution in both homeopathy and alopathy, and the fallacies of randomized controled trials and metanalyses.

It also highlights the paradox that while western medicine aims, claimsto be science-based, for daily minor consultations in the better-off  it is largely in daily practice  the art of  temporizing medicine, symptom-based palliation while the underlying stressor, be it emotional or infection, subsides spontaneously. And apart from trauma, or infection, or the small percent of adults with the most common deadly genetic diseases  eg Huntingdon’s chorea or haemophilia which can only be palliated,  for chronic common  diseases of aging there are no modern drugs which address the rckbasic degenerative pathogenesis.

Metformin the 85year old extract of the age-old medicinal galega officinalis is the only prescription “drug” which does so, in the appropriate dose and patient a true panacea since (like fish oil)  it addresses virtually every pathogenetic mechanism of obesity- lipidemia- diabetes, hypertension- heart-vascular-renal, retinopathy, dementia and hypoimmunity. Quality cannabis the Forbidden Medicine is similarly a powerful multidisease therapy, while vastly safer as a recreational dependency than heavily marketed tobacco smoking, gratuitous sex, alcohol and sugar products-the four horsemen of the apocalypse-  after human bloodlust- mass starvation, violence,  murder and warfare the greatest killers of all ..

But  homeopathy is like religion: ineffable, unprovable. As  the great Dane Søren Kierkegard the founder of modern psychology and  fierce critic of the Church wrote almost two centuries ago,  personal religion (as opposed to tribal membership) can only be by a leap of faith, a suspension of reason. The theologian Karen Armstrong, the scientist Steven Jay Gould, the London philosophers AC Greyling and John Gray, and many top novelists – George Elliott,   Hermann Wouk, Margaret Attwood and John Fowles – have written perceptive books dissecting  true religion- which is at worst a harmless fulfilling moral code – and caring calling-  for many, except when (like religion and medicine through the ages) abused for political domination and greed in the pursuit of power by the ruthless. Homeopathic physicians surely  cannot be thus accused, unlike the Disease Industry and Big Pharma ..  Homeopathy did not, like mainstream medicine in Hahneman’s time, incarcerate and even neuter  like animals the feeble and the  sad with the bad irrespective.

It is commonly said that one in three admissions to USA hospitals, and thousands of premature deaths there  each year, are iatrogenic, contributed to by modern medicines and rash surgery. Except in nondiagnosis of serious treatable illness which progresses by neglect, this cannot happen with homeopathy.

But if these beliefs and organized practices- homeopathy, reflexology, craniosacral medicine, faith healing, personal (not dictated) religion, nutritional supplements in moderation by experience –   are harmless, are they better or worse than most modern marketed chronic drugs, which mostly prove for common chronic conditions eventually  to be inferior to old and proven remedies, if they do not collapse or fall into neglect within years of their launch from adverse effects or disillusion. Examples are non-steroidal anti-inflammatory analgesics including coxibs (compare to the enduring paracetamol, and analgesic herbs); bisphosphonates (compare to appropriate ancient anabolic supplements including enduring appropriate HRT), or statins and glitazones (compare to ancient metformin and other natural antioxidants); or the troublesome angiotensin blockers for common hypertension (compare to gold standard old  low dose reserpine plus low dose coamilozide) .

In that context of inquiry one can read this exposition by a naturo-/homeopathic physician with well over 50 years of practice experience on the observations and teachings of Hahnemann, a profoundly observant and ethical medical practitioner, linguist and scientist for his times. . . he was certainly the first and most famous medical doctor of modern times. Although Edward Jenner was four years his senior and William Harvey two centuries earlier, they made their mark each in only one field, whereas Hahnemann applied his mind to all disease – both chronic, infectious, poisoning and the humane care of the insane. He was eerily prophetic of our modern Disease Industry- sell at any cost: “he  claimed that the medicine of his time did as much harm as good: ‘My sense of duty would not easily allow me to treat the unknown pathological state of my suffering brethren with these unknown medicines. The thought of becoming in this way a murderer or malefactor towards the life of my fellow human beings was most terrible to me’ .” If only the FDA and it’s devotees would follow this principle before applying relatively untested new drugs where well-proven old have long existed.

It is not inconceivable that molecular biology may yet, paradoxically,  explain by quantum mechanics a theoretical basis for homeopathy, setting it aside from pseudoscience and quackery, since modern critical reviews still leave room for doubt. .

ndb

`HOMEOPATHIC BASICS (June  ’09)   Dr. Ron Beare ND., DHomMed, South Africa.

“It is amazing to think that Dr. Samuel Hahnemann MD  (1755-1843), a German physician and the Founder of homeopathy, http://en.wikipedia.org/wiki/Samuel_Hahnemann lived at a time when medicine recognized bloodletting and purging, mixtures made from vipers, opium, mercury; and other physically degrading poisons.

He was always mindful of the teachings of that other genius Hippocrates, Father of herbal medicine.

Hippocrates, the Father of Natural/Herbal Medicine, died about 400 years before the Christian era.

It is he whose Hippocratic Oath defines the Code of medical ethics even to-day.

Hippocrates denied the then superstitious causes of disease.

He stated in lectures and books that feelings and thought came from the brain, not the heart or liver (as it was thought for centuries before and after Hippocrates).

He was the first dr. to describe epilepsy and pneumonia.

He also said that physicians should do no harm.

Because health is our greatest blessing, we must always improve our lifestyles, by walking, diet and hygiene.

Some 2000 years after Hippocrates’ entreaties about Natures’ healing without perpetrating invasive harm;  Dr. Samuel Hahnemann (1755-1843) established a vibrant energy type of medicine, based on the totality of each patient’s individual symptoms.

“The Removal of the Totality of Symptoms means the Removal of the Cause” (Kent, “Lectures on Homeopathic Philosophy”).

FOR MILDER PAIN, WHY USE NSAIDS OTHER THAN PARACETAMOL -ACETAMINOPHEN?

It is 4 months since this column last addressed nonsteroidal anti-inflammatory drugs NSAIDs.

A new study (from USA, UK and Canada – Ray 2009) of NSAIDs  claims that in those with ischemic heart disease, the popular NSAIDS -diclofenac, ibuprofen or rofecoxib(Vioxx) – increased serious heart disease/ death by about 50-67% compared to nonusers; whereas naproxen over some 111000 patient years of use gives no significant risk or benefit.

A new study from Denmark (Fosbol 2009) this year looked at a million healthy individuals with no hospital admissions or selected therapy. Compared to no NSAID use, ibruprofen and naproxen gave no added risk of death/ myocardial infarction; diclofenac gave 67% increased risks, and the two coxibs (rofecoxib Vioxx; celecoxib Celebrex)  increased risk 100%.

So we are led to believe that naproxen or ibuprofen is the NSAID  mild-to-moderate analgesic  of choice. Naturally the American Colleges and academia – who represent the Disease Industry, not patients- recommend yet other potentially toxic drugs- like  the magical proton pump inhibitors- to counteract the adverse NSAIDS..

But is this just a myopic view beloved of big pharma, to promote their snake oils.?

Another new study from Denmark (Gislason 2009) of 110 000 patients after admission for heart failure in the 12 years 1994-2005, showed that 57% died; 9000 (8%) were rehospitalized with acute heart attack  and 40 000 (38%) were rehospitalized with heart failure. Thus heart failure in a well-nourished population has a poor prognosis. In 36 000 who had used NSAIDs compared to non-users, risk of death was doubled on  diclofenac; increased~67% on  (rofe-or cele)coxibs; and was  significantly increased 22-31% by all other NSAIDs including naproxen and ibruprofen.

It is common cause after 20 years that injected diclofenac is the only NSAID that can unpredictably cause sudden death. So it’s administration risks culpable homicide when it is totally unwarranted. No cases of sudden death from any oral NSAID   including aspirin appear on Medline, apart perhaps from the risk of hyperacute asthma (Asamoto 1999).

But what of gastrointestinal bleeding  risks of NSAIDS? a 2007 study in Japan (Yajima) scoped all orthopaedic patients who took NSAIDs for more than 4 wks: oral diclofenac increased risk of erosive gastric lesions sixfold. A new review from Seattle (Schlansky 2009) refers to Helicobacter synergism in all NSAID use.

WHAT IS THE NEED FOR NSAIDS? The Wikipedia entry on NSAIDs  sums it up: it has almost four times as much text on the numerous  adverse effects of NSAIDs as on their uses- in fact the  article does not discuss the advantages of NSAIDS as analgesics; in fact it states plainly  that alone  just  “their gastrointestinal effects  are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States”.

All designer drugs are dangerous in overdose. Without overdose, paracetamol has no risk – and the Wikipedia entry thereon is balanced and highly favourable even for infants. We know well that paracetamol- a fatal liver toxin in overdose- should not be marketed without a built-in simple liver (and antineuritic) protective of  eg (carbo-or N-acetyl-)cysteine, alphalipoic acid and vitamin BCo.  But the Disease – Big Pharma Industry is not interested in prevention- Only Disease Pays. And Regulators, lobbyists and legislators  protect their source of work and income- the Drug Industry.

Fish oil (EPA+DHA) is probably  the most beneficial NSAID supplement we have (- perhaps ahead of other front-runners like vitamins C, D, magnesium and CoQ10-) halving all sudden deaths, and reducing by at least a third all major chronic degenerative diseases from CVD to diabetes, arthritis, learning, depression, behaviour disorders. Industry wont pay for head-on comparative trials. But the trial evidence suggests that fish oil and oral EDTA have better risk-benefit than aspirin and other antiplatelet agents, NSAIDs and warfarin.

We know that for moderate trauma and small – medium (even knee) joint pain/  contusions, self-massage with any natural NSAID like arnica or wintergreen is all that is needed, combined if necessary orally with up to 3 to 4gm paracetamol /day +- if needed a little codeine.   Prior 2002 found no significant difference in pain relief between paracetamol and naproxen in tension headache.

For more serious pain,  short of strong opioids, there is in fact no overall trial evidence that weak opioids or NSAIDs are better than eg hypnotherapy, or acupuncture,  or judicious paracetamol; to which latter if necessary a little codeine can be added as step-up analgesia. The latter  agents have none of the deadly risk of NSAIDs. Amadio 1984 showed that of Peripherally Acting Analgesics: ” paracetamol at up to 4 g per day compares favorably in analgesic potency to aspirin and other NSAIDs, and  should be considered the treatment of choice for mild-to-moderate pain”.  Skovlund 1991 showed no significant difference between naproxen and paracetamol in postpartum uterine spasms.

Six RCTs – five in mostly European peoples and one in Hong Kong- found paracetamol equal to diclofenac (Voltaren) – March 1994 in arthritis; Brevik 1999 and Kubitzek 2003 in dental surgery; Hoogewijs 2000 and Woo 2006 after trauma; and Munishankar 2008 after Caesarian section.  In a Cochrane analysis 2003, Towheed showed that in the one placebo-controlled RCT in osteoarthritis, paracetamol was clearly superior to placebo with a similar safety profile. And the general principle of therapy applies, that if required, combination of analgesics from different groups is better than single drug therapy. But given the many potentially fatal risks of the NSAIDs – compared to paracetamol, opioids and if indicated  aspirin -  there is no compelling reason to add NSAIDs  for pain.

We know that it is negligent to initially sentence people with  spontaneous mild-moderate head/neck/backache or tendonitis at the shoulder, elbow, knee etc to bedrest, NSAIDS, opioids or referral for xrays, scans or surgery. 95% will settle rapidly with reassurance, posture instruction and simple topicals and paracetamol analgesia. Otherwise most pain will disappear with firm reassurance with brief simple laying on of hands eg massage and traction with gentle rotational manipulation and instruction in auto-reinforcement -  pressure point eg earlobe pressure, or acupuncture, or hypnosis. And most of the remainder resolve quickly with  simple targeted injection with a little local anaesthetic plus depot steroid.

And we know that with judicious use, topical corticosteroid injection – never mind judicious brief systemic steroid (corticosteroid, calciferol, testosterone) has little or no risk and far greater target and multisystemic benefit than NSAIDs; and for chronic conditions, like fish oil at least address the underlying pathogenic mechanisms/causes- whereas NSAIDs and paracetamol ignore these.

Is drug-speeded resolution of inflammation essential and beneficial except for the drug vendor? A careful RCT by Bradley ea from Indiana University in 1992 observed that “joint tenderness and swelling, presumptive evidence of synovitis, may not be a priori indications for use of an antiinflammatory drug, or predict greater responsiveness to treatment with an antiinflammatory drug than to a pure analgesic, in symptomatic treatment of patients with knee osteoarthritis”.

So why are synthetic  NSAIDs and especially the Coxibs  still used? Why do academics and Regulators still allow, promote  them for  routine use, other than to profit Big Pharma, and cause perhaps a quarter million deaths a year globally?