Monthly Archives: April 2009

WARNING: INSULIN THERAPY TRIPLES MORTALITY IN TYPE 2 DIABETICS WITH NORMAL-to-RAISED C PEPTIDE

A report today from Hong Kong finds that   “insulin-treated type 2 diabetics with high C peptide are at a significantly higher risk of cardiovascular events (hazard ratio [HR] 2.85, p = 0.049) and death (HR 3.43, p = 0.043)”.

Thus insulin should be added only in uncontrolled type 2 diabetics with low C peptide.

Those with normal to high C peptide levels apparently have good insulin output, thus insulin resistance.

The corollary is that, rather than insulin and insulin secretagogues/ mimetics, these patients  simply need better diet and oral  insulin sensitizers.

Yet we continue to see patients  gaining weight and getting sicker  on insulin (and sulphonylureas and glitazones) , instead of them being guided to better diet ( fat-free cooking, sugar-free, low in fruit juice, salt, cornstarch)  and natural  supplementary   insulin sensitizers to tolerance (ie galega/metformin, the dozen minerals and vitamins, at least 10 human biologicals, fish oil and a choice of a thousand herbs.

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UPDATE AMERICAN HYBRID SWINE ‘FLU (H1N1) SPREAD:

In future see updates at  https://healthspanlife.wordpress.com/2009/05/03/a-false-flu-alarm-what-is-killing-mexicans-in-the-current-flu-outbreak/

Update 26 May 06h00 GMT: The world tally for LABORATORY-CONFIRMED H1N1 American (swine/ Mexican) flu  infections in 52 countries is as follows: 12 570cases:

The AMERICAS: 17 countries: USA6764  Mexico4541; Canada921;  Panama 76;  Chile 82; Costa Rica 28; Peru 27;  Colombia 13; Ecuador 24,  Brazil 9, El Salvador 6;  Guatamala4;   Cuba 4,   Argentine 19; Paraguay 1; Nicaragua 1; Honduras 1;  DEATHS 98.

EUROPE  21 countries: Spain 136; Portugal 1; UK137; Ireland 1  ,  Belgium 7, Netherlands 3, France 19,  Germany 17,  Italy 19   Austria 1,  Switzerland 1,   Greece 1; Turkey 2;  Israel 8; Norway 4;  Finland 2; Sweden 3;  Denmark 1, Poland 2,   Russia 2; Iceland 1; Kuwait 18; UAE 1;

East/Asia: 12 countries: Japan350, China 20; Taiwan 5;  S Korea 23; Thailand 2;  Cambodia 1;  Malaysia 2; India 3;  New Zealand 9, Australia 31; Philippines 1;

All reported  98 associated deaths have been on the North American continent –  apparently still only 14 deaths in non-Mexicans;  ie Americans  11, Costa Rican 1 and Canadian 2- and all in apparently  previously vulnerable/  ill patients. There is still no clarity as to whether any of the associated 81 deaths in Mexicans occurred in previously healthy well and adequately housed and fed  patients

Update 25 May 06h00 GMT: The world tally for LABORATORY-CONFIRMED H1N1 American (swine/ Mexican) flu  infections in 50 countries is as follows: 12 570cases:

The AMERICAS: 17 countries: USA6552  Mexico4174; Canada805;  Panama 76;  Chile 74; Costa Rica 28; Peru 25;  Colombia 12; Ecuador 12,  Brazil 9, El Salvador 6;  Guatamala4;   Cuba 4,   Argentine 5; Paraguay 1; Nicaragua 1; Honduras 1;  DEATHS 93.

EUROPE  21 countries: Spain 133; Portugal 1; UK133; Ireland 1  ,  Belgium 7, Netherlands 3, France 16,  Germany 17,  Italy 19   Austria 1,  Switzerland 1,   Greece 1; Turkey 2;  Israel 8; Norway 4;  Finland 2; Sweden 3;  Denmark 1, Poland 2,   Russia 2; Iceland 1; Kuwait 18; UAE 1;

East/Asia: 12 countries: Japan345, China 16; Taiwan 5;  S Korea 22; Thailand 2;  Cambodia 1;  Malaysia 2; India 3;  New Zealand 9, Australia 18; Philippines 1;

All reported  93 associated deaths have been on the North American continent –  apparently still only 12 deaths in non-Mexicans;  ie Americans  10, Costa Rican 1 and Canadian 1- and all in apparently  previously vulnerable/  ill patients. There is still no clarity as to whether any of the associated 81 deaths in Mexicans occurred in previously healthy well and adequately housed and fed  patients

Update 24 May 19h00 GMT: The world tally for LABORATORY-CONFIRMED H1N1 American (swine/ Mexican) flu  infections in 49 countries is as follows: 12 545cases:

The AMERICAS: 17 countries: USA6552  Mexico4174; Canada805;  Panama 76;  Chile 55; Costa Rica 28; Peru 21;  Colombia 12; Ecuador 10,  Brazil 9, El Salvador 6;  Guatamala4;   Cuba 4,   Argentine 1 ; Paraguay 1; Nicaragua 1; Honduras 1;  DEATHS 92.

EUROPE  21 countries: Spain 126; Portugal 1; UK133; Ireland 1  ,  Belgium 7, Netherlands 3, France 16,  Germany 17,  Italy 14;   Austria 1,  Switzerland 1,   Greece 1; Turkey 2;  Israel 7; Norway 4;  Finland 2; Sweden 3;  Denmark 1, Poland 2,   Russia 1; Iceland 1; Kuwait 18;

East/Asia: 12 countries: Japan342, China 16; Taiwan 5;  S Korea 21; Thailand 2;  Cambodia 1;  Malaysia 2; India 3;  New Zealand 9, Australia 17; Philippines 1;

All reported  92 associated deaths have been on the North American continent –  apparently still only 11 deaths in non-Mexicans;  ie Americans  9, Costa Rican 1 and Canadian 1- and all in apparently  previously vulnerable/  ill patients. There is still no clarity as to whether any of the associated 81 deaths in Mexicans occurred in previously healthy well and adequately housed and fed  patients.

Update 23 May 05h00 GMT: The world tally for LABORATORY-CONFIRMED H1N1 American (swine/ Mexican) flu  infections -in 47  countries  is as follows: 12 457 cases:

The AMERICAS: 17 countries: USA6552  Mexico4174; Canada805;  Panama73;  Chile 44; Colombia 12; Ecuador 8, Peru 17; Costa Rica 26;  Brazil 9, El Salvador 6;  Guatamala*4;   Cuba 4,   Argentine 1 ; Paraguay 1; Nicaragua 1; Honduras 1;

EUROPE  20 countries: Spain 126; Portugal 1; UK120; Ireland 1  ,  Belgium 7, Netherlands 3, France 16,  Germany 17,  Italy 14;   Austria 1,  Switzerland 1,   Greece 1; Turkey 2;  Israel 7; Norway 4;  Finland 2; Sweden 3;  Denmark 1, Poland 2,   Russia 1;

East/Asia: 10 countries: Japan321, China 11; Taiwan 5;  S Korea 5; Thailand 2;  Malaysia 2; India 3; New Zealand 9, Australia 14; Philippines 1;

All reported  92 associated deaths have been on the North American continent* –  apparently still only 11 deaths in non-Mexicans;  ie Americans  9, Costa Rican 1 and Canadian 1- and all in apparently  previously vulnerable/  ill patients. There is still no clarity as to whether any of the associated 81 deaths in Mexicans occurred in previously healthy well  patients.

Update 22 May 19h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 46 countries – 11 163 cases:

The AMERICAS: 17 countries: USA*6552  Mexico*4008; Canada*719;  Panama*73;  Colombia 12*; Ecuador 8, Peru 16; Costa Rica* 26;  Brazil* 9, El Salvador* 7;  Guatamala* 3;   Cuba 4,   Chile 29*; Argentine* 1 ; Paraguay 1; Nicaragua 1; Honduras 1;

EUROPE  20 countries: Spain** 118; Portugal 1**; UK**117; Ireland 1 ** ,  Belgium 5**, Netherlands** 3, France** 16,  Germany**  17,  Italy** 14;   Austria 1**,  Switzerland 1**,   Greece 1**; Turkey 2;  Israel* 7; Norway** 4;  Finland 2**; Sweden 3**;  Denmark 1**, Poland 2**,   Russia 1;

East/Asia: 10 countries: Japan***317, China 11; Taiwan 5;  S Korea*** 4; Thailand 2***;  Malaysia 2; India 3; New Zealand*** 9, Australia 13***; Philippines 1;

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 90, apparently still only 11 deaths in non-Mexicans  ie Americans  9, Costa Rican 1 and Canadian 1- and all in apparently  previously vulnerable/  ill patients. There is still no clarity as to whether any of the associated 79 deaths in Mexicans occurred in previously healthy well  patients.

Update 21 May 05.30 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 44 countries – 11  167 cases:

The AMERICAS: 16 countries: USA*5764  Mexico*3892; Canada*719;  Panama*69;  Colombia 12*; Ecuador 8, Peru 2; Costa Rica* 20;  Brazil* 8, El Salvador* 6;  Guatamala* 3;   Cuba 4,   Chile 25*; Argentine* 1 ; Paraguay 1; Nicaragua 1;

EUROPE  19 countries: Spain** 111; Portugal 1**; UK**112; Ireland 1 ** ,  Belgium 5**, Netherlands** 3, France** 16,  Germany**  14,  Italy** 9;   Norway** 4;  Finland 2**; Sweden 3**;  Denmark 1**, Poland 2**,  Austria 1**,  Switzerland 1**,   Greece 1**; Turkey 2;  Israel* 7;

East/Asia: Japan*** 292, China 8; Taiwan 3;  S Korea*** 4; Thailand 2***;  Malaysia 2; India 3; New Zealand*** 9, and Australia 10***; Philipines 1;

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 87, apparently still only 11 deaths in non-Mexicans  ie Americans  9, Costa Rican 1 and Canadian 1- and all in apparently  chronically  ill patients. There is still no clarity as to whether any of the associated 76 deaths in Mexicans occurred in previously healthy well  patients. More demographic details are awaited, but the CDC today notes that obesity is obviously a major risk factor- as usual.

Update 20 May 07h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 42 countries – 10 390 cases:

The AMERICAS: 14 countries: USA*5469  Mexico*3734; Canada*516;  Panama*59;  Colombia 12*; Ecuador 1, Peru 2; Costa Rica* 9;  Brazil* 8, El Salvador* 4;  Guatamala* 3;   Cuba 3,   Chile 11*; Argentine* 1 ;

EUROPE  18 countries: Spain** 107; Portugal 1**; UK**107; Ireland 1 ** ,  Belgium 5**, Netherlands** 3, France** 16,  Germany**  14,  Italy** 9;   Norway** 3; Finland 2**; Sweden 3**;  Denmark 1**, Poland 2**,  Austria 1**,  Switzerland 1**,   Greece 1**; Turkey 2;  Israel* 7;

East/Asia: Japan*** 262, China 7; Taiwan 1;  S Korea*** 4; Thailand 2***;  Malaysia 2; India 3; New Zealand*** 9, and Australia 5***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 82, apparently still only 9deaths in non-Mexicans  ie Americanos  7, Costa Rican 1 and Canadian 1- and all in  chronically  ill patients. There is still no clarity as to whether any of the associated 75 deaths in Mexicans occurred in previously healthy well  patients. More demographic details are awaited, but the CDC today notes that obesity is obviously a major risk factor- as usual.

Update 19 May 17h30 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 41 countries – 10 232 cases:

The AMERICAS: 14 countries: USA*5469  Mexico*3648; Canada*516;  Panama*59;  Colombia 11*; Ecuador 1, Peru 2; Costa Rica* 9;  Brazil* 8, El Salvador* 4;  Guatamala* 3;   Cuba 3,   Chile 10*; Argentine* 1 ;

EUROPE  18 countries: Spain** 103; Portugal 1**; UK**102; Ireland 1 ** ,  Belgium 5**, Netherlands** 3, France** 14,  Germany**  14,  Italy** 9;   Norway** 2; Finland 2**; Sweden 3**;  Denmark 1**, Poland 2**,  Austria 1**,  Switzerland 1**,   Greece 1**; Turkey 2;  Israel* 7;

East/Asia: Japan*** 191, China 7;  S Korea*** 4; Thailand 2***;  Malaysia 2; India 1; New Zealand*** 9, and Australia 1***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 80, apparently still only 7 deaths in non-Mexicans  ie Americanos  5, Costa Rican 1 and Canadian 1- and all in  chronically  ill patients. There is still no clarity as to whether any of the associated 73 deaths in Mexicans occurred in previously healthy well  patients.

Update 18 May 15h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 40 countries 8862 cases:

The AMERICAS: 14 countries: USA*4714;  Mexico*3103; Canada*516;  Panama*55;  Colombia 11*; Ecuador 1, Peru 1; Costa Rica* 9;  Brazil* 8, El Salvador* 4;  Guatamala* 3;   Cuba 3,   Chile 2*; Argentine* 1 ;

EUROPE  18 countries: Spain** 103; Portugal 1**; UK**101; Ireland 1 ** ,  Belgium 5**, Netherlands** 3, France** 14,  Germany**  14,  Italy** 9;   Norway** 2; Finland 2**; Sweden 3**;  Denmark 1**, Poland 2**,  Austria 1**,  Switzerland 1**,   Turkey 2;  Israel* 7;

East/Asia: Japan*** 135, China 6;  S Korea*** 3; Thailand 2***;  Malaysia 2; India 1;      New Zealand*** 9, and Australia 1***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 76 , apparently still only 7 deaths in non-Mexicans  ie Americanos  5, Costa Rican 1 and Canadian 1- and all in  chronically  ill patients. There is still no clarity as to whether any of the associated 69 deaths in Mexicans occurred in previously healthy well  patients.

Update 17 May 19h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 40 countries 8817 cases:

The AMERICAS: 13 countries: USA* 4714;  Mexico*3102; Canada* 516;  Panama* 54; Colombia 11*; Ecuador 1, Peru 1; Costa Rica* 9;  Brazil* 8, El Salvador* 4;  Guatamala* 3;   Cuba 3,   Argentine* 1 ;

EUROPE  18 countries: Spain** 103; Portugal 1**; UK**101; Ireland 1 ** ,  Belgium 5**, Netherlands** 3, France** 14,  Germany**  14,  Italy** 9;   Norway** 2; Finland 2**; Sweden 3**;  Denmark 1**, Poland 2**,  Austria 1**,  Switzerland 1**,   Turkey 2;  Israel* 7;

East/Asia:  8Japan*** 93, China 7;  S Korea*** 3; Thailand 2***;  Malaysia 2; India 1;    New Zealand*** 9, and Australia 1***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 75 , apparently still only 6 deaths in non-Mexicans  ie Americanos  4, Costa Rican 1 and Canadian 1- and all in  chronically  ill patients. There is still no clarity as to whether any of the associated 69 deaths in Mexicans occurred in previously healthy well  patients.

Update 16 May 07h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 34 countries – 8485cases USA* 4714;  Mexico* 2895; Canada* 518; Spain** 103;  UK** 85; Panama* 43; France** 14, Germany**  14, New Zealand*** 9, Italy** 9;  Costa Rica* 8;  Brazil* 8, Israel* 7,   Colombia 11*;  Japan*** 4, Belgium 4**,  China 4***; El Salvador* 4; Guatamala* 3;  Netherlands** 3,  Cuba 3, S Korea*** 3; Thailand 2***;  Norway** 2; Finland 2**; Sweden 2**;   Poland 2**, Malaysia 2, and one  each Ecuador, Peru; Argentine*;   Ireland**,  Austria**, Denmark**,  Switzerland**,  Portugal**;  and Australia***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 73 , apparently still only 6 deaths in non-Mexicans  ie Americanos  4, Costa Rican 1 and Canadian 1- and all in  chronically  ill patients. There is still no clarity as to whether any of the associated 67 deaths in Mexicans occurred in previously healthy well  patients.

Update 15 May 06h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 34 countries – 7737cases USA* 4298;  Mexico* 2656; Canada* 449; Spain** 100;  UK** 78; Panama* 39; France** 14, Germany**  12,  Italy** 9;  Costa Rica* 8;  Brazil* 8, Israel* 7,  New Zealand*** 7, Colombia 10*;  Japan*** 4,  China 4***; El Salvador* 4; Guatamala* 3;  Netherlands** 3,  S Korea*** 3; Thailand 2***;  Norway** 2; Finland 2**; Sweden 2**;   Belgium 2**, and one  each Cuba*; Argentine*;   Ireland**,  Austria**, Denmark**,  Switzerland**,   Poland**, Portugal**;  and Australia***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 70 , apparently still only 5 deaths in non-Mexicans  ie Americanos  3, Costa Ricna 1 and Canadian 1- and all in  chronically  ill patients. There is still no clarity as to whether any of the associated 65 deaths in Mexicans occurred in previously healthy well  patients.

Update 14 May 21h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 34 countries – 7673cases USA* 4298;  Mexico* 2656; Canada* 389; Spain** 100;  UK** 78; Panama* 39; France** 14, Germany**  12,  Italy** 9;  Costa Rica* 8;  Brazil* 8, Israel* 7,  New Zealand*** 7, Colombia 7*;  Japan*** 4,  China 4***; El Salvador* 4; Guatamala* 3;  Netherlands** 3,  S Korea*** 3; Thailand 2***;  Norway** 2; Finland 2**; Sweden 2**;   Belgium 2**, and one  each Cuba*; Argentine*;   Ireland**,  Austria**, Denmark**,  Switzerland**,   Poland**, Portugal**;  and Australia***.

All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 69 , apparently still only 4 deaths in non-Mexicans  ie in USA, Costa Rica  and Canada- and all in previously very ill patients. There is still no clarity as to whether any of the associated 65 deaths in Mexicans occurred in previously healthy well young patients.

Update 13 May 20h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 33 countries – 6483cases, plus ??  suspected  cases;  USA* 3370Mexico* 2446; Canada* 358; Spain** 100;  UK** 71; Panama* 29; France** 13, Germany**  12,  Italy** 9;  Costa Rica* 8;  Brazil* 8, Israel* 7,  New Zealand*** 9, Colombia 7*;  Japan*** 4,  China 4***; El Salvador* 4; Guatamala* 3;  Netherlands** 3,  S Korea*** 3; Thailand 2***;  Norway** 2; Finland 2**; Sweden 2**; Argentine  2*;  and one  each Ireland**,  Austria**, Belgium**, Denmark**, Switzerland**,   Poland**, Portugal**; Australia***;  Cuba*.

Update 12 May 20h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 33 countries – 6042cases, plus ??  suspected  cases;  USA* 3139Mexico* 2282; Canada* 330; Spain** 98;  UK**  68; Panama* 18; France** 13, Germany**  12,  Italy** 9;  Costa Rica* 8;  Brazil* 8, Israel* 7,  New Zealand*** 7,  Japan*** 4,   Netherlands** 3,  El Salvador* 4; Guatamala* 3;  Colombia 6*; S Korea*** 3; Thailand 2***;  Norway** 2; Sweden 2**; China 2***; and one  each Ireland**,  Austria**, Denmark**, Switzerland**,  Finland 2**; Poland**, Portugal**; Argentine  2*; Australia***;  Cuba*.  All reported associated deaths so far have been on the North American continent* – the total deaths now amount to 63 , apparently still only 4 deaths in non-Mexicans  ie in USA, Costa Rica  and Canada.

update 11 May 14h00 GMT: the rate of new cases seems to be dropping everywhere, altho laboratories are catching up with the backlog to reveal the extent of those outbreaks in the minority of  regions which could afford or bothered with  testing. Only 4% of confirmed cases have been reported outside the Americas-  and of the 221 cases elsewhere , 202  have been in the 13 European coastal ie Atlantic-Baltic-Mediterranean  countries.

The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 30 countries (up from 19 a week ago) – 5351 cases, plus >1500  suspected  cases;  USA* 2733 plus another 433 suspected;  Mexico* 2062; Canada* 284; Spain** 95; UK**  65; France** 13, Germany**  11,  Italy** 9; Costa Rica* 8; Brazil* 8, Israel* 7,  New Zealand*** 7,  Japan*** 4, S Korea*** 3; Netherlands** 4, Guatamala* 3;  El Salvador* 4;   Panama* 15; Colombia 3*; Norway** 2; Sweden 2**; and one  each Ireland**  Austria ** Denmark**, Switzerland**,  Poland**, Portugal**; Argentine *   Australia***; China ***  and  Hong Kong***.  All reported associated deaths so far have been on the North American continent.

ie proven swine flu cases:  5021 in the Americas*; 204 in Europe-Israel**; and 17  in the West Pacific arc***. The relative population size in millions of the  USA : Mexico: Canada  is 309 to 109 to 36; so it is to be expected that the total number of Americans infected (let  alone dying)  will be 3 times higher than of  Mexicans let alone 15 times higher than of Canadians. But the deaths outside Mexico attributable to swine flu are simply not happening. Hence the growing feeling that the deaths in Mexicans are due to another bug so far eluding detection eg strep pneumonia- which would not be detected unless different specimen are cultured. .

61  deaths (57 in Mexicans) have now been reported in patients with confirmed swine flu, but only 28 have so far been  clearly and solely attributed to the virus (not other causes) –  all in Mexicans (another 100 deaths suspect); (plus another 33 deaths  with swine flu virus  but not proven attributable eg   in  very high risk patients  – all Mexicans, plus 2  Americans, a Canadian and a Costa Rican) .   The attributable death rate in (near) Mexicans  relative to all proven cases there is thus ~2.8%, but none  directly related elsewhere away from the Mexican border

update 10 May 15h00 GMT: The  tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections is as follows ( confirmed cases reported by all countries):  world- 30 countries (up from 19 a week ago) – 4571 cases, plus >1500  suspected  cases;  USA* 2432 plus another 433 suspected;  Mexico* 1626 (plus  >533 suspected cases); Canada* 280; Spain** 95; UK**  48; France** 12, Germany**  11,  Italy** 9; Costa Rica* 8; Israel* 7,  New Zealand*** 7, Brazil* 6, Japan*** 4, S Korea*** 3; Netherlands** 3, Guatamala* 3;  El Salvador* 2;   Panama* 2;  Norway** 2; and one  each Ireland**  Austria ** Denmark**, Switzerland**,  Poland**, Portugal**, Sweden**; Argentine * Colombia*;  Australia*** and  Hong Kong***. All reported deaths so far have been on the North American continent.

ie proven swine flu cases:  4364 in the Americas*; 194 in Europe-Israel**; and 16  in the West Pacific arc***. The relative population size in millions of the  USA : Mexico: Canada  is 309 to 109 to 36; so it is to be expected that the total number of Americans infected (let  alone dying)  will be 3 times higher than of  Mexicans let alone 15 times higher than of Canadians. But the deaths outside Mexico attributable to swine flu are simply not happening. Hence the growing feeling that the deaths in Mexicans are due to another bug so far eluding detection eg strep pneumonia- which would not be detected unless different specimen are cultured. .

Although 53 deaths have now been reported in patients with confirmed swine flu, only 28 have been attributed to the virus (not other causes) –  all in Mexicans (another 100 deaths suspect); (plus another 25 deaths  with swine flu virus  but not proven attributable eg   in  very high risk patients   in 21 Mexicans, in  2  Americans, a Canadian and a Costa Rican .   The attributable death rate in (near) Mexicans  relative to all suspected  cases there is thus ~1.2%, but none  directly related elsewhere away from the Mexican border.

update 9 May 15h00 GMT tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections as follows ( confirmed cases reported by all countries):  world- 29 countries- 4040 cases , plus >1500  suspected  cases;  USA 2224 plus another 412 suspected;  Mexico 1364 (plus  >533 suspected cases); Canada 242; Spain 93; UK  39; France 12, Germany  11,  Italy 8; Israel 7,  New Zealand 7, Brazil 6, Netherlands  3, Japan 3, S Korea 3;  El Salvador 2;   one  each Ireland  Austria  Denmark, Switzerland,  Poland, Portugal, Sweden; Argentine  Colombia, Costa Rica;  Guatamala;  Panama; Australia and  Hong Kong.

ie proven swine flu cases:  3843 in the Americas; 180 in Europe-Israel; and 15  in the West Pacific. The relative population size in millions of the  USA : Mexico: Canada  is 309 to 109 to 36; so it is to be expected that the total number of Americans infected (let  alone dying)  will be 3 times higher than of  Mexicans let alone 15 times higher than of Canadians. But the deaths outside Mexico attributable to swine flu are simply not happening. Hence the growing feeling that the deaths in Mexicans are due to another bug so far eluding detection eg strep pneumonia- which would not be detected unless different specimen are cultured. .

Only 28  deaths attributed to   proven Mexican  flu have been confirmed – all in Mexicans (another 100 deaths suspect); (plus another 20 deaths  suspect but not proven attributable eg  one  each in  a very high risk woman each in an American woman (cause of death not disclosed)  and  Canada (died from asthma).   The attributable death rate in (near) Mexicans  relative to all suspected  cases there is thus ~1.5%, but none  directly related elsewhere away from the Mexican border.

The above stats do not mean that the outbreak has not occurred everywhere. It may simply be that cases (and deaths) are indistinguishable from other infections in vast areas like Africa, Arabia, Russia, China, and are not being monitored and tested for reporting in >70% of the world’s people & countries. .

update 8 May 19h00 GM tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections as follows ( confirmed cases reported by all countries):  world- 26 countries- 3446 cases , plus >3300  suspected  cases; Mexico 1364 (plus  >1700 suspected cases); USA 2224 ;  Canada 242; Spain  93; UK  40; Germany  11, France 12,Israel 7,  New Zealand 7, Italy 8;  Brazil 6,Netherlands  3,  S Korea 3;  El Salvador 2;   one  each  Argentine 1, Colombia, Costa Rica;  Guatamala;   Ireland  Austria   Denmark, Switzerland,  Poland, Portugal, Sweden; and  Hong Kong.

ie proven swine flu cases:  3255 in the Americas; 174 in Europe-Israel; and 9 in the West Pacific. The relative population size in millions of the  USA : Mexico: Canada  is 309 to 109 to 36; so it is to be expected that the total number of Americans infected (let  alone dying)  will be 3 times higher than of  Mexicans let alone 15 times higher than of Canadians. But the deaths outside Mexico are simply not happening – and even in Mexico, the fatality rate among those swine flu positive is s0 far only 0.4%

48  deaths associated with  proven Mexican  flu have been reported – 46 in Mexicans (another 100 deaths suspect); ( one in  a very high risk American woman Texan  living on the Mexican  border severely obese, already pneumonic after recent childbirth; and one in a very high risk elderly Canadian woman in Canada;).  The death rate in (near) Mexicans  relative to all suspected  cases is thus ~1.5%, but none  directly related elsewhere away from the Mexican border. The impression grows that the new hybrid strain is in fact less virulent than the seasonal flu viruses long circulating around the world; and that in Mexico and elsewhere, as in 1918 , deaths are either where this new mild virus has become the final tipping straw, or else death is in fact due not to the incidental swine flu virus but to a co-infecting bug – eg the strep pneumonia (which killed most in the ’18  H1N1 epidemic) or one of the prevalent virulent influenza A  N2- or N3- or N5-H.. viruses.

Update 6 May 20h00 GMT: tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections as follows (no longer reporting WHO figures as up to yesterday, but confirmed cases reported by all countries):  world- 23  countries- 2267 cases , plus >4100 suspected  cases; Mexico 1112 (plus  >2955 suspected cases); USA  831 ;  Canada 165; Spain  81; UK  32; Germany  9, France 7,New Zealand 5, Italy 5; Israel 4, El Salvador 2;  S Korea2;   one  each  Colombia, Costa Rica;  Hong Kong; Netherlands  Ireland  Austria   Denmark, Switzerland,  Poland, Portugal, Sweden, Guatamala..

ie confirmed cases: the Americas  1726 ie 92.6% ;  W Europe+ Israel 134;  west  Pacific  6; Africa O; mainland EurAsia O.

Update 5 May 21h00 GMT: tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections as follows:  world- 21 countries-  1478 cases , and 833  suspected probable cases; Mexico 806 (out of >2950 suspected cases); USA  405 ;  Canada 140; Spain  57; UK  28; Germany  9, New Zealand 6, Italy 5; Israel 4, France 4, El Salvador 2;  S Korea2;   one  each  Colombia, Costa Rica;  Hong Kong; Netherlands  Ireland  Austria   Denmark, Switzerland, Portugal.

ie confirmed cases: the Americas  1355 ie 90% ;  W Europe+ Israel 113;  west  Pacific  6; Africa O; mainland EurAsia O.

27 deaths associated with  proven Mexican  flu have been reported – only   in Mexicans (another 101 deaths suspect). 5 were 13yrs or younger, 4 over 60yr. The death rate in Mexicans relative to all suspected  cases is thus about 1%.

Update 4 May 17h00 GMT: tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections as follows:  world- 21 countries-  1103cases out of >4600  suspected probable cases; Mexico 590 (out of >2500 suspected cases; USA  293 ;  Canada 101; Spain  54; UK  27; Germany  8, New Zealand 6, Israel 4, , El Salvador 2; France 4,  Italy 4;   one  each  Colombia, Costa Rica; S Korea, Hong Kong; Netherlands  Ireland  Austria   Denmark, Switzerland, Portugal.

ie confirmed cases: the Americas  949; W Europe+ Israel 103;  west  Pacific  6; Africa O; mainland Asia O.

26 deaths associated with  proven Mexican  flu have been reported – only   in Mexicans (another 101 deaths suspect). 5 were 13yrs or younger, 4 over 60yrs.

update 3 May 16h00 GMT:  Mexico, USA, Canada, UK   and Spain have extra cases confirmed, and  3 new confirmed related deaths in Mexico- the last in  midweek- but no new countries have confirmed cases since yesterday.  Now another 11 suspicious  cases have reportedly died in Mexico since yesterday.  But no evidence of confirmation has been disclosed.   SO THERE IS NO PANDEMIC, and no spreading epidemic- only North America is heavily involved.  So the only slight possibility of this mild flu epidemic outside the Americas is in Western Europe.

People die everyday – the majority suddenly- of both common and bizarre  causes.  It is hair-raising that after a month, there are still no reports anywhere to indicate whether deaths in cases with the hybrid American flu virus had any clear cause of death attributable to the virus eg virus meningitis, virus pneumonitis, virus carditis, virus hepatitis,  etc. So there is no proof yet that this H1N1 virus has actually killed anyone (as  opposed to them dying of malnutrition, exposure, bacterial or other viral  infection, cancer, diabetes, heart disease etc, although also carrying the new hybrid H1N1 virus). Is the analogy AIDS? where the cause of death is often secondary infections.

tally for LABORATORY-CONFIRMED American (swine/ Mexican)  flu infections as follows: world- 19 countries-  909 cases out of >4120  suspected probable cases; Mexico 506 (out of >2500 suspected cases; USA  233 (and another 514 probable?) ; Canada 85; Spain  44; UK  18 (and another 9 probable?), Germany  8, New Zealand 4, Israel 4, Costa Rica 2, France 2 (and another 7 probable?),  Italy 2;   one  each  Colombia, S Korea, Hong Kong; Netherlands  Ireland  Austria   Denmark, Switzerland.

ie confirmed cases: N America  826; W Europe+ Israel 83;  west  Pacific  6; Africa O; mainland Asia O.

20 deaths associated with  proven Mexican  flu have been reported – only   in Mexicans (another 101 deaths suspect). 4 were 13yrs or younger, 4 over 60yrs. No autopsy results yet confirm whether overwhelming Mexican flu has actually caused a single death. . . The associated death rate in Mexico is   still only 4% of confirmed cases – which means that by now – if it is the American swine virus causing death- around  18 deaths could have been expected in non-Mexicans. But so far there have been no very ill cases or suspicious deaths  except in Mexicans . . is this just a false alarm, or a profiteering conspiracy?

update 2 May 17h00 GMT:   THERE IS NO GLOBAL EPIDEMIC NOR THREATENED PANDEMIC. Despite a gross  of  recent flu cases being screened in Australia, not one has so far been positive for the hybrid virus there. And very few cases of person-to-person transmission have been reported outside Mexico. Outside Mexico, the cases have been milder than the seasonal flu that kills tens of thousands of elderly folk every year.

SEE THE UPDATED PRECAUTIONS/TREATMENT.

tally for confirmed American (swine/ Mexican)  flu infections are as follows:  world- 17 countries-  714 cases (up from 265 in  3 days- out of >4700  suspected probable cases); Mexico 443; USA in 3days doubled from 64 to 162; UK  15, Canada-13 to 55, Spain 4 now 15; Germany  6, New Zealand-4, Israel-3, Costa Rica-2, France 2,  one  each Netherlands  Ireland  Austria   S Korea  Denmark, Hong Kong, Switzerland.       Africa O.

(“Confirmed” is where the specific virus has been isolated.)

25 other countries have suspect cases.

17 Deaths associated with  swine flu have been reported only   in Mexicans – but no autopsy results yet reported to confirm whether swine flu has actually caused a single death. . .

This recalls the experience in the 1918 H1N1 Spanish flu  epidemic that deaths were due to superinfection with strep pneumonia- which is easily treated with antibiotics, although antibiotic resistance may now be high in countries  where antibiotics are freely available and overused.

There have been no more deaths or serious cases related to this American hybrid flu virus reported- but more tests are awaited to see if the deaths in Mexicans could be related to eg a different H1N1 virus, or to strep pneumonia that speculatively accounted for most of the  1918 flu epidemic deaths.

update 1st May GMT 17hoo: the identifying name of this virus is a problem: the first case  was in USA, not Mexico. But the brunt, and all deaths, have been in Mexicans. The virus is a mix of human, bird and swine genetic material- but this hybrid  hasn’t been found in swine yet. There have been lots of type A H1N1 viruses – and worse- around the past century.

so the handle of American  hybrid  flu is the most appropriate.

The reference labs are swamped with backlog of  samples from suspect cases, so the number of confirmed cases and countries will rise- but the number of new suspects seems to be leveling off- with no new serious cases reported from Mexico, and still none serious  anywhere else in the world. There is no sign of a pandemic.

But the news bulletins say nothing about the 2500 cholera deaths in 40 000 cases in Zimbabwe..

Apart from probable cases, the  tally for confirmed swine flu infections are as follows:  world- 17 countries-  533 cases(up from 265 in  2days- out of >4400  suspected probable cases); Mexico 312; USA in 48hrs doubled from 64 to 141; Canada-13 to 35, Spain 4 now 13; UK  11, Germany  4, New Zealand-4, Costa Rica-2, Israel-2,  one  each Netherlands  Ireland  Austria   S Korea  Denmark, Hong Kong, Switzerland, China    ..  South Africa O.

13 confirmed  Mexican  deaths reported  related  to the swine virus – but without autopsies, not  proven that they were due to the swine flu. Other nationals no deaths.

Except in Mexicans, nothing more than average flu symptoms have been reported in confirmed  or probable cases.  So the mystery remains: why have only Mexicans died with this virus?   Deaths  cannot be  from the swine virus alone if no-one but  Mexicans have died from it.

And until autopsy details are released from Mexico confirming that the “confirmed cases” died from overwhelming swine flu, there is no confirmation that this swine flu outbreak is even virulent.

But already the outbreak has become a multibillion dollar windfall for USA between antiviral, vaccine and screening kits.. and a costly disaster for airlines due to the media hype. So far there is no indication to start mass-producing vaccine that will only be available months hence, when the new virus is likely to have greatly changed it’s genetics by then.

Since the outbreak did not start in Mexico but in USA, and is a hybrid avian+ swine+human virus, the least confusing is to stick with the name swine flu- there are worse earlier H1N1 viruses around the world.

update 30 April 17h00 GMT: at midday GMT there  were apparently 108 confirmed swine flu cases reported in the USA- up from 64 +- 36hrs before.

update 30 April 07h00 GMT “The UN’s World Health Organization (WHO) has raised the alert over swine influenza to level five – one short of a pandemic. A phase five alert means human-to-human transmission in at least two countries.”  Only 8 of of the   168 confirmed cases of swine flu have died in Mexico.

Independent on line an hour ago says two  suspect cases have been reported  locally, in Gauteng and West Cape. But so far there has not been a single case of serious illness in  let alone danger for a  non-Mexican in or coming out of Mexico, nor in  anyone who has been in contact with travelers from Mexico. So there is no justification  for the media hysteria, nor for the risky costly American antiviral drugs. All suspect cases so far (other than in Mexicans)  have been average mild flu – and very few cases have been confirmed with the virus even  in Mexico. Many cases of our regular flu this season have been worse than confirmed swine flu cases in non-Mexicans .

So there is nowhere near a pandemic on the horizon- just a lucrative scare for media, for Disease Agencies like the CDC and WHO, American Authorities and the Disease Industry- laboratories and (American) Drug and vaccine and H1N1 screening kit  companies, and pharmacists!.

update 29 April 21.30 GMT: 10 US states have now reported 121  suspect swine virus cases including 1 death in Texas, a visiting toddler from Mexico. Total 2917 suspect cases worldwide .  120 deaths  in Mexicans (few have yet been confirmed as due to swine H1N1)  with 168 cases confirmed swine H1N1 cases out of >2700 suspected cases. . The WHO tally for confirmed infections are as follows: US-64, Canada-13, Britain-5, Spain-4, Germany-3, New Zealand-3, Costa Rica-2, Israel-2, and Austria-1.. none yet in RSA or Australia or Asia or Africa.

update 29  April 07h34 GMT so far good  news-  just on 2000 cases reported from Mexico- but no further deaths there, and no serious cases anywhere else in the world. They are looking frantically for an alternative reason for the deaths – 152 so far reported ,  but few as yet confirmed swine virus –  in Mexicans.

updated 28 April 2009 15h20 GMT. The USA and then WHO  today declared Swine flu  a level 4 health emergency, a pandemic.  See the up-to-the minute report .. it has spread around the world in 2 months.

But so far – unlike in previous flu epidemics-  there are no reports of serious illness eg pneumonia, encephalitis, carditis,  collapse or deaths outside Mexico, not even on the latest Australian or CDC websites.

Why is this swine H1N1 virus affecting especially those between the ages of ~20 – 50yrs?

50years  from 2009= 1959. So the last related outbreak must have been before that time- to give us oldies immune memory protection: perhaps we acquired some  genetic  immune resistance from our parents who survived the 1918 ( also H1N1 swine virus ) flu pandemic (my father was a warden in that epidemic- which killed one of his 11 siblings; his parents, and my grandmother’s parents, had survived the perilous journey out of Russia in the early 1880s, likely after surviving  the great flu epidemic of 1857-9).

But this doesn’t explain why the current outbreak also spares those under 20years.

But we peak in the mid-20s, that’s when all systems start aging.. . and in first-world communities, most are attending group educational institutes if not living carefree for most of those youth years, possibly enhancing group immunity, and before the real stresses of work and kids and smoking and alcohol  hit us…

However, it is  futile to speculate on the affected agebracket since virtually all cases originate in Mexico, where diet, ecology  and lifestyle must be radically different from the other countries whose citizens have been affected.

Why are deaths occurring only in Mexicans? especially when no trace of swine flu has been detected on the piggeries there?

is it Hispanic genes making them more susceptible?

is it an as-yet unidentified bug that is unmasked by/ coincidental to the mild flu contagion that tourists are carrying out?

is it a local acute or chronic toxin that the Mexicans have been exposed to that makes them more vulnerable to this swine flu?

The fact that in Mexico it is mainly the 25-45yr olds who have been affected points especially to workplace exposure? what is the smoking, drug usage, diet, vocational and gender spread of the victims? The first confirmed case of swine flu occurred in California days before the first reported case in Mexico.

Shades of Jose Samargo’s brilliant 1995 novel Blindness, in which an unidentified contagion in an unnamed country inflicts white blindness on almost everyone – and no-one is ever referred to by name.  Shades of New World and Olde World  peoples 500 years ago who were decimated when previously unknown infections scythed through them, brought in by immune humans or eg rodents. Shades of the carnage of AIDS in subSaharan Africa but no-where else, about which conspiracy theories circulate.

PRECAUTIONS against both ‘flu and colds: see the list.

No swine flu cases have yet been reported from  Africa; but with pandemic TB, AIDS, cholera etc, and winter biting hard this month to herald the usual bad flu season, it will be harder to distinguish acute swine flu from other potential  flu/ common cold infections.

Take this list and go ask you local infectious disease specialist, as well as your health care provider-  but above all, take the simple preventative nonprescription  steps listed .. .

So far the most deaths have been reported in  Mexicans ( apparently <2% of those infected – compared to the global estimated deathrate of  2.5% in 1918)  – and only 11  (so far) in visitors with flu returning home  from Mexico ie 0.3%. So this may turn out to be another profitable false alarm for USA Big Pharma to mass-sell antivirals and imminent specific vaccines- as apparently happened after the SARS scare a few years ago, which fortunately  never became the predicted  fatal global  pandemic..

help-line ph +0027836299160.

Healthspan Life!*

ndb

FOR URGENT ATTENTION: THE CASE OF ANTIHYPERTENSIVES: PROTEST THE OMISSIONS FROM NATIONAL ESSENTIAL DRUG LISTS:

quotations and study evidence are in italics. Links are underlined.

On 14 April The South African Department of Health emailed us : ”  the Council  of Medical Schemes (CMS)  is reviewing the prescribed minimum benefit (PMB) regulations. Stakeholders are again invited to comment, this time before 11 May 2009, on the  third draft of the consultation document with input from stakeholders.” Antihypertensive medicines listed in the PMB EDL Essential Drug List are:  “Amlodipine Atenolol Enalapril Hydralazine Hydrochlorothiazide Methyldopa Sodium nitroprusside.”

Please submit as a comment to this motivation (or/and direct to CMS)  your argument for or against the evidence-based changes proposed to the EDL.

Judging from the antihypertensives, diuretics and estrogen listed, the PMB EDL  is anything but evidence-based. How can the EDL omit the prime human replacement hormones estradiol, progesterone; diotroxin; and cholecalciferol vitamin D3? when no substitutes eg ergocalciferol D2, levothyroxin  or the xenohormones  ethinylestradiol, premarin or progestins  can be proven  as good and safe.

For the long-standing evidence-based reasons set out below, the  long-used lowcost combination  co-amilozide  (amiloride + HCTZ hydrochlorothiazide) must be added to the diuretics (amiloride is on the European EDL), and reserpine to the antihypertensives list.

We all around the world are stakeholders. The argument over the best betablocker is trivial compared to the major issue that the longest- and best-proven drugs for hypertension- lowdose reserpine and co-amilozide –  are omitted. This omission will  drive up cost, but more important  (as on the RSA, and UK, and European Medicine Authority Essential Drug  Lists where reserpine is omitted) deprive patients of the best primary drugs- of huge concern considering that prevalence figures of overweight insulin- resistance hypertension and lipidemia are fast approaching 50%; with respiratory disorders (which most modern antihypertensive drugs,  except CCB calcium-channel blockers, may aggravate)  not far behind.

It is alarming that – thanks to ill-advised Guidelines  and unthinking doctors – we still see overweight older patients on atenolol plus HCTZ- with potassium level of 2.9mmol…

This week’s Medical Jnl of Australia has two commentaries on Treatment Guidelines that are very relevant to us everywhere. Where are the declarations of lack of vested interests of role-players in the South African  and UK and European Essential Drug Lists?

Ted Dace recently reviews Corporate Bias, Corporate skepticism: Turning doubt into dollars, the strategy evolved by Industry (cigarette, mineral, phenylpropanolamine, fertilizer and GM food)  to delay action against their products by casting doubt on the evidence against them.

Now, as Dace and Flavio Fuchs say, Big Pharma has strategically reversed the disinformation game by using the skepticism tactic, and Big Pharma  financial leverage  (through jobs and taxes) on Regulators and politicians, to have natural unpatentable nutriceutical supplements- even essential vitamins minerals and biologicals like fish oil and human hormones – and long out-of-patent proven old drugs- discredited by blatantly wrong data, or subjected to far more stringent evidence of benefit and lack of harm than is presently required for heavily marketed patent drugs. The latter- (provided they are owned by US pharma corporates) are allowed to be registered and marketed with only a few months trials in humans- even though very few such synthetic drugs (eg stilbestrol; practolol; thalidomide; fenphen; cerivastatin, troglitazone, psychotropes, Vioxx) survive more than a few years due to unanticipated (or blatantly  undisclosed) major adverse effects, and even though they are allowed to be registered and saturation marketed despite there being  no good evidence that they are as good as let alone better and safer than the old.

Hence the increasing disaster of unnecessary multirisk modern patent drugs:

*NSAIDS and Cox-2 inhibitors (Vioxx, Celebrex) with no advantage over sensible aspirin,  paracetamol or eg cat’s-claw-curcumin herbal blends for ordinary pain;

* statins for mild “hypercholesterolemia” when all that is needed is sensible diet-exercise and nutriceuticals;

* oral xenohormones (eg premarin, progestins, ethinylestradiol  instead of evolution-proven parenteral human sex hormone replacement;

* bisphosphonates and newer patent drugs when all that is needed to prevent osteoporosis and linked fractures is appropriate combination of vitamins B,C,D3,K; calmag, zinc, boron, manganese; and testosterone and estradiol; and

* sulphonylureas and glitazones for the epidemic of type 2 diabetes when all that is usually needed is restriction of sucrose- fructose and cooked fats, and addition of metformin or the available scores of natural insulin sensitizers.

Smoking aside, mild hypertension and insidious overweight (with some degree of insulin resistance, low nitric oxide and increased reactive oxygen species contributing to lipidemia, atheroma and tissue glycation- AGES advanced glycation endproducts) are the most prevalent – and correctable-  risk co-markers for adult obesity, diabetes,  ischemic heart disease, heart -kidney failure, cancer, stroke, dementia and premature death. These risk factors are easily detected and warned about  at any consultation with a healthcare provider, even the pharmacist, nurse or naturopath. And they are  easily and cheaply reversed with safe simple  lowcost advice and prescription of  antihypertensive antifattening agents : lowdose reserpine+coamilozide, and natural supplements (vitamin-minerals, and biologicals like fish oil, arginine, carnitine, coQ10, galega/metformin, gymnema, garlic, curcumin and  pepper).

The case of hypertension: Corporate bias and the molding of prescription practices: this thoughtful critique by Flavio Fuchs from Brazil last month  sums up the massive Disease + Regulator Industry fraud in most marketing and  current  national drug recommendations – which favour modern marketed antihypertensive drugs over the old and proven combination: “Commercial strategies .. based on the results of clinical trials sponsored by drug companies. Most ..  present distortions in their planning, presentation or interpretation that favors the drugs from the sponsor, i.e. corporate bias.  Atenolol, an ineffective blood pressure agent in elderly individuals, was the comparator drug in several trials. In a re-analysis of the INSIGHT trial, deaths appeared to have been counted twice. The LIFE trial appears in the title of more than 120 reproductions of the main and flawed trial, as a massive strategy of scientific marketing. Most guidelines have incorporated the corporate bias from the original studies, and the evidence from better designed studies, such as the ALLHAT trial, have been largely ignored.  In trials published recently corporate influences have touched ethical limits. In the ADVANCE trial, elderly patients with diabetes and cardiovascular disease or risk factors, allocated to placebo, were not allowed to use diuretic and full doses of an ACE inhibitor, despite the sound evidence of benefit demonstrated in previous trials…. This reality should be modified immediately, and a greater independence of the academy from the pharmaceutical industry is necessary. “ Dr Fuchs has some 108 publications, 38 as first author, on Pubmed the past 25years.

But new studies validate (or spuriously attempt to discredit) the still- primary role of lowdose reserpine+ coamilozide in the prevention and treatment of hypertension and associated Alzheimers, diabetes, heart- kidney disease and premature mortality:

Arya ea 2009 show that reserpine ” increases longevity of the 1mm long roundworm Caenorhabditis elegans with a high quality of life, namely, enhanced and prolonged mobility (Srivastava et al 2008); and in this well established Alzheimer’s model, reserpine ameliorates Abeta toxicity, significantly delayed paralysis and increased longevity “. .

Patterson Dollery & Haslam in 1965 in London;  Rosenfeld in 1980; and the Multicenter Diuretic Cooperative Study Group in 1981, already showed that co-amilozide -hydrochlorothiazide HCTZ plus amiloride -was more potent than either alone in lowering bloodpressure, while  generally reversing the hypokalemia of essential hypertension- but without reduction in the severe hyperuricemia of HCT alone.

The Cache County Study in 2006 showed that potassium-sparing diuretic (eg co-amilozide) was the only antihypertensive drug that in the treatment of hypertension lowered the incidence of Alzheimer’s disease – by 75%.

For 30years, studies and trials with lowdose reserpine -the VA study of 1982 and the 1997 German Reserpine Study Group ( in overweight hypertensives with baseline hypokalemia  lipidemia and hyperglycemia) have shown that adding lowdose reserpine 0.05 to 0.125mg/d to thiazide (eg HCTZ, chlorthalidone or clopamide) reduces the metabolic problems inherent in essential hypertension and diuretics ( potassium -magnesium deficiency, raised uric acid- glucose cholesterol and triglyceride levels).

In 2002 Shafi ea at London University showed that in rats on an atherogenic diet, reserpine even at a high parenteral dose of 43mcg/kg/day (equivalent to > >0.25mg orally/d in average humans) reduced blood and vessel wall LDL by 1/4/ to 1/2, and aorta intima-media thickness by 3/4; HDL and triglyceride levels were unchanged. .

In 1995 Grobee & Hoes and in 1999 Cooper ea reported that non-potassium-sparing diuretics almost double the risk of sudden (arrhythmic) deaths compared to potassium-sparing drugs or addition of potassium.

Each potassium-sparing agent has it’s  promoter, but amiloride does not have the feminizing effects of spironolactone, and is the only one that also conserves essential magnesium. Spironolactone deserves  it’s place on the EDL, but so does amiloride.

And finally, metanalysis (Burman 2004) of  the ~ dozen trials each of  non-potassium-sparing diuretic (in at least 116 000 patients) or reserpine (in at least 7400 patients) spread over 20 years , against other antihypertensive drug, shows that reserpine alone or (co-)thiazide alone is as good as or better than any well-tried modern drug eg ACEI,  ARB(angiotensin-converting enzyme inhibitor or ARB angiotensin receptor blocker), betablocker or CCB calcium channel blocker alone.

The two German Reserpine Study Group trials (Pittrow ea 1997) showed in 400 overweight hypertensives that the combination of reserpine 0.1mg plus a thiazide -clopamide 5mg/d – was considerably better than an ACEI  or CCB  alone (about 60% had hypertension normalized versus elalapril 29% or nitrendapine 45%); And without the cough/ angioedema, arrhythmia or rash problems of ACEI, ARBS or CCBs. . .

Big Pharma Disinformation: Fernandes ea 2009 found that in rats, “low doses” of reserpine preferentially induce deficits in tasks involved with emotional contexts. But the dose they used was anything but low dose for humans: they used 0.1-0.5mg/day reserpine / kg in rats- but given the recognised ~10 times faster metabolism of rodents,  this dose converts in humans to ~0.01- 0.05 mg/kg ie for an average 75kg adult 0.75 to 1.375mg/day. The lowdose regime long recognised for humans is around 0.025 to 0.075mg/day. So they were using a dose about 12 to 30 times higher- which we stopped using decades ago.

And a followup 2009 analysis Shafi ea from the landmark Systolic Hypertension In the Elderly SHEP trial  showed the folly of continuing to use diuretic dose of thiazide to treat  essential hypertension- especially when combined with atenolol which compounds metabolic and respiratory adversity. Chlorthalidone even 12.5 mg or less a day almost doubled the risk of diabetes in the first year, and >25mg/d combined with atenolol trebled the risk; whereas combination with a potassium supplement neutralized the risk of diabetes – potassium depletion being the mediator of thiazide-induced diabetes..

Sica in 2006 analysed the consensus that in terms of diuretic and antihypertensive efficacy, chlorthalidone is more than twice as potent at hydrochlorothiazide HCTZ ie chlorthalidone 25mg = >50mg HCT. Yet we know from patient observation that even 7mg/d coamilozide combined with reserpine 50mcg/d  is effective antihypertensive.  Adversity from highdose chlorthalidone clopamide or HCT (which should not be used for uncomplicated hypertension)  is irrelevant to the modern optimal management of hypertension..

A little alcohol is healthy- but most people use much more (as well as cigarettes)  at their peril, and society does nothing except bury the corpses and fork out insurance.. So  it is classic fraud, cynical hypocrisy for Regulators and Big Pharma to quote overdosed drugs as reason not to use eg low dose reserpine or low dose co-amilozide.

CONCLUSION: It is not co-amilozide let alone reserpine that deserves the second look proposed by Barzilay ea 2007; – these  are the long-established sine-qua-non first, second and third-line drugs for treatment of all grades of essential hypertension, as world hypertension experts eg Profs Marvin Moser, Norman Kaplan,  MK Mani, YK Seedat, Roy Keeton and Harry Seftel have long advised. As Professor Fuchs implies, it is the regulators and gatekeepers in all countries – the Governments/Medicines Control Councils, the Hypertension Societies and the Medical Aid Schemes, that must produce – if necessary by order of  a Court of Law – evidence to justify the omission from national essential drug lists of lowdose coamilozide with lowdose reserpine as the first pharmacological tier for all grades of essential hypertension. This proven regime (currently costing retail prepacked in RSA about US$6/year), together with enforced advice about low salt-lowfat- low sugar /alcohol diet, natural essential  supplements, active exercise and no smoking, is all that most hypertensive patients need.

UPDATE 2016: DO NONINVASIVE INNOVATIONS REVERSE MAJOR CHRONIC BRAIN DAMAGE ?

update Dec 2016:  Psychiatrist neuroplastician Dr Norman Doidge in his  books   on How the Brain Changes(prev.  2008); and then  How it  Heals Itself (2015), expands on the brain’s unique capacity to neuroplastically adapt and recover functions either by neuronal regrowth or by finding new pathways. https://www.theguardian.com/books/2015/jan/23/the-brains-way-healing-stories-remarkable-recoveries-norman-doidge-review.   He details numerous landmark discoveries the past century about how diverse integrative noninvasive methods can help the brain heal, including cognitive, nutritional, physical, laser and electro/magnetic innovations- ideally early but even years later, in conditions ranging from cerebral palsy and  autism, to stroke, multiple sclerosis, traumatic brain injury and  blindness,  to Huntingdons chorea,  Parkinsons and dementias. ..

Dr EL Tobinick has since 2003  continued to report progressive improvement in neurological results with peripheral invasive ie perispinal etanercept injection, as his latest paper references.

Over the same ~15year period, Dr CG Coimbra neurologist at Sao Paulo University Brazil has proven increasingly the value of a nutritional regime including megadose vitamin D3 in reversing multiple sclerosis and other serious autoimmune diseases. http://www.vitamindandms.org/researchers/coimbra/ and  https://healthspanlife.wordpress.com/2016/05/17/vitamins-k2-with-d3-the-vitamins-of-the-next-decade/

As Dr Doidge stresses, such landmark innovations  take decades to be confirmed, especially if there are no new devices or drugs that can be marketed to generate  massive profits (and jobs)  for (the Disease) Industry, and governments and politicians via more jobs and taxes. And drug companies and the Disease and Hospital Industry will not fund the necessary major studies without medium-term major profit incentive- especially if the innovations are major prevention and cure, reducing the profitable disease burden. Thus the USA delayed recognizing the major role of metformin and  lithium carbonate  for some 25 years, and medicinal cannabis  for almost 50 years., to protect their moneyspinning Big Pharma new synthetic drug inventions- none of which have proved enduringly safe and effective as have the old natural discoveries.

CNS Drugs.2016 Jun;30:469-80.   Perispinal Delivery of CNS Drugs.   Tobinick EL  Institute of Neurological Recovery.  Florida. Perispinal injection is a novel emerging method of drug delivery to the central nervous system (CNS). Physiological barriers prevent macromolecules from efficiently penetrating into the CNS after systemic administration. Perispinal injection is designed to use the cerebrospinal venous system (CSVS) to enhance delivery of drugs to the CNS. It delivers a substance into the anatomic area posterior to the ligamentum flavum, an anatomic region drained by the external vertebral venous plexus (EVVP), a division of the CSVS. Blood within the EVVP communicates with the deeper venous plexuses of the CSVS. The anatomical basis for this method originates in the detailed studies of the CSVS published in 1819 by the French anatomist Gilbert Breschet; then rediscovered by American anatomist Oscar Batson in 1940; with additional supporting evidence discovered in the publications of American neurologist Corning. Analysis suggests that Corning’s famous first use of cocaine for spinal anesthesia in 1885 was in fact based on Breschet’s anatomical findings, and accomplished by perispinal injection. The therapeutic potential of perispinal injection for CNS disorders is highlighted by the rapid neurological improvement in patients with otherwise intractable neuroinflammatory disorders that may ensue following perispinal etanercept administration.      full paper and published peerreviewed references at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920856/

 

upodate 2009:  Regrettably, there is as yet apparently  no objective group clinical follow-up from Dr Tobinick or other clinicians since  this column’s first report of February 2008 of instantaneous and sustained improvement in Alzheimer’s disease after etanercept (Enebrel) perispinal injection.

Search under this heading on Pubmed and Google  yields material clinical papers only by the originator of this therapy Dr Tobinick.

The videos on line of February 2009 giving up to 4 year  followup of  a few individual recovered patients are exciting  but anecdotal.

Professor Tobinick’s February 2009 paper describes elegant  imaging of localization of labeled etanercept in the brain in a rat model.

Search of Pubmed for etanercept adverse effect in other uses  yields a report of two cases of sarcoidosis after etanercept; almost doubling of the risk of cancer; and increased occurrence of psoriasis.

But in a relentless deadly disease like Alzheimers, these adverse events pale into significance if etanercept reverses  dementia’s progression  for even a few months, when no modern designer drugs in common use show any significant benefit as opposed to adverse effects.

So further report on durability of improvement from etanercept in Dr Tobinick’s group of patients, and confirmation of this application by other clinicians, is keenly awaited by many.

How many success stories have there been with etanercept in AD, against how many AD patients treated with etancercept in total? and what has been the average duration of remission compared to those not treated with the magic injection?

There is  one report giving  more recent detail, apparently a newspaper interview  dated 12 April 2008 that  says Dr Tobinick’s group has  “treated around 50 patients at a private clinic by injecting  etanercept, into the spinal column in the neck. .They claim 90 per cent respond to the treatment, usually within minutes.”

This response rate and speed bears out the promise of their report of a year ago; but there is no mention of such results on their website or anywhere else.  Hence the skepticism of the British Alzheimer Society’s website .

RESERPINE: WHY ARE IT’S BENEFITS FOR HYPERTENSION BEING IGNORED?

It is now a lifetime ago  since the detailed trial report  showing  the major blood-pressure-lowering  benefit of reserpine on it’s own (without any diet/ salt restriction) in moderate hypertension  by Lieutenant-Colonel Inder Singh in the BMJ in 1955 (fulltext on line).

A Cochrane review of reserpine undertaken in 2000 by Manyemba ea from the Goodenough Trust in London was abandoned without explanation last year, but taken up the same day  by the Department of Medicine,  University of British Columbia on the  Blood pressure lowering efficacy of reserpine for primary hypertension.

The University of British Columbia motivation is that

-“Reserpine is an anti-hypertensive drug that was used as a first-line drug in the late 1950’s [Liebowitz 1957, Blackman 1959] and early 1960’s and recently has been used as a  second-line therapy [SHEP 1991, ALLHAT 2002]. The reasons for using it as (ie relegation to) second-line therapy are not very clear, but it is generally believed that the development of newer antihypertensive medications with better side effects profile rendered reserpine less favourable.”

But there is no evidence to support this aggressive but unsubstantiated marketing hype by lobbyists for the New Drug Industry. Such faith in the divine benignity of registered  drugs and drug companies was laid to rest by the ill-advised Women’s Health Initiative, which – without any clinical precedent for safety- subjected some 12000 “asymptomatic” women over the age of 60years to oral  xenohormone (equine estrogen plus/minus progestin)- with increasing adverse effect the older they were.

-”  Thiazides are the first-line treatment due to their proven benefit in terms of morbidity and mortality [Wright 1999, ALLHAT 2002]. However, other drugs such as ACE (angiotensin converting enzyme) inhibitors, ARBs  (angiotensin II receptor blockers), beta blockers, and calcium channel blockers, have been used as first-line treatments as well. The evidence for these drugs is not as convincing as that for thiazides”.

-“Why it is important to do this review? : More recent studies have shown that reserpine doses of 0.1-0.25 mg daily are effective in reducing blood pressure as monotherapy and doses as low as 0.05 mg daily maybe effective when combined with a diuretic [Vet Admin 1982]. It is rational then to evaluate the efficacy of these new regimens before undermining reserpine’s potential benefit especially when considering its convenient dosage schedule and low cost compared to the newer more expensive alternatives. Reserpine remains to be used in some countries as an antihypertensive drug.”

-“More data about the efficacy of various doses of reserpine in reducing blood pressure is therefore needed to guide future clinical practice and research. The goal of this systematic review is to evaluate the dose related efficacy of reserpine, compared to placebo or no treatment, in reducing blood pressure.”

As this column has regularly reviewed the past two years, the evidence and experience is overwhelming that once-daily (or even 3 times a week) lowdose reserpine plus lowdose co-amilozide is the best initial treatment – costing perhaps US$6/year-  for all grades of essential hypertension- starting with one or even two tablets of tablet of each briefly initially; and  if necessary a 4th (modern) appropriate antihypertensive drug added in rare emergency circumstances. The only exception might be  moderate-to-severe kidney failure, when the co-amilozide would be replaced by furosemide.

And of course management of hypertension includes addressing the risk factors for all the degenerative diseases of aging-

*exercise;   *stress reduction;   *less salt and (cooked) fat intake;

*reversing overweight  and insulin excess (if necessary with permanent metformin) to prevent diabetes;

*supplementing fish oil, magnesium and other appropriate micronutrients  eg vitamins and biologicals including i.a.  coQ10, carnitine, arginine and  appropriate non-oral HRT;

* avoidance of smoking, and excess of alcohol, caffeine, corticosteroid and sex hormones.

But after the results of German trials and the SHEP and ALLHAT trials a decade ago confirmed reserpine and thiazides (especially co-amilozide)   separately to be as good as if not better than newer drugs, no drug company will dare  risk  low-dose reserpine plus (co)thiazide to be tested against any modern patent drug/ combination.

THE CRUCIAL IMPORTANCE OF NON-ORAL ROUTE and LOWER DOSE OF SEX HORMONE REPLACEMENT SHRT in the majority-the overweight, diabetic, cardiac, thrombosis, transplant, dementia and cancer risks.

Obviously our   skin (unless injured or diseased) – arguably our  major organ of heat control, sweating, vitamin D activation  and sexual enticement- serves as a major impenetrable barrier to  absorption or leakage. Unlike amoebae- which live or die by their exterior- we feed and excrete via our digestive tract, using our skin mainly for attraction-  or repulsion!.

It is common cause that, with intravenous injection ivi as the fastest alternative route (to swallowing), absorption is hardly better (than the skin) across aged dry vagina; better across moist ie mucous membranes eg of the eyes, nose, mouth and vagina/rectum; better by deep inhalation or subcutaneous s.c. placement (injection or pellet); and best  by intramuscular injection imi – which is now rarely achieved with  a standard 3/4 inch needle into the upper outer buttock in a fattening population . Such injections are mostly delivered s.c.

Which route is preferable depends obviously on the speed of action required eg high blood peak for an urgently needed antibiotic, analgesic, anaesthetic, antiasthma, acute insulin or resuscitation; as opposed to slow smooth delivery for maintenance eg hormone, antidepressant or analgesic delivery.

For depot injections, why use anything bigger than a 25g 10mm long needle?  so that safe subcutaneous   s.c.i.  is ensured,  guaranteeing  avoidance of the many minor and major risks of intramuscular   imi.

eg Meyer ea at Cornell Univ NY 1990 reported  that subcutaneous administration of the gonadotropin releasing hormone agonist leuprolide took half the time to first response with double the amount absorbed compared to the same dose by the transdermal TD route.

Minto, Handelsman ea in 1997 showed that injection of an oil-based depot sex hormone into the fattier gluteal (ie upper outer buttock) region (as compared to the lean deltoid ie upper arm true imi) gave significantly slower smoother less peaked absorption and action of the hormone.

And obviously total delivery to the body is going to be less absorbed  through the tightly layered  skin than if 100% delivered under the skin by injection/implant. Fatty – steroidal- gonadal hormones are particularly altered by digestion and transhepatic absorption. But so will transdermal absorption fall with aging, drying of the skin.

Hence in postmenopausal women PMW  the average dose equivalence for similar symptom- hot flash- relief has been found to be estradiol 1mg or CEE 0.625mg orally, but about 0.05mg E2  a day by modern TD designer patch (containing 4mg E2, changed twice a week)  or cream;  ie an effective oral: TD dose ratio of about 20:1. But  oral estrogen eg 1mg E2 raises the E1 estrone (the hormone most associated with breast cancer) blood level  5-fold more than the E2 level, and increases urine estrogen excretion about 100fold; whereas the E2 patch 0.05mg/day raises serum E2 to a satisfactory ~120pmol/L  but with  little  increase in E1 level  or urine estrogen excretion. Thus TD but not oral ET restores the youthful healthy balance of blood E2>E1 aout 1.2 :1.

Conversely, in  girls with delayed puberty and growth,   physiological effect appears to be even higher with TD estradiol  E2  than oral conjugated oral estrogen CEE Premarin. In a recent trial undeveloped girls with Turner’s syndrome were randomly assigned to receive initially  CEE 0.3mg/d orally, or TD E2 0.025mg/d patch (17β-estradiol, Vivelle TD) for one year – doses chosen based on published E2  equivalence  about 20:1. After 12 months the girls on TD ERT had better improvement in uterine, height, breast, and bone density growth than oral HT CEE. Hence they too (like postmenopausal  PMW) needed far lower total dose estrogen exposure parenterally than orally. PMW certainly rarely if ever want bigger breasts or womb, so even lower transdermal microdoses are ideal for them.

Nachtigal ea 2009 show that oral but not TDE2 accelerate platelet reactivity ie thrombosis risk in some PMW.

Villa ea 2008 show that low dose 1mg/d micronized E2  lowers insulin resistance, whereas higher dose 2mg/d increases it.

Verhoeven ea 2006 showed that oral micronized E2, but not TD  E2 treatment, significantly reduced arginine compared with placebo – and good arginine levels are crucial in maintenance of immunity; insulin sensitivity;   growth hormone output; wound repair; fertility; and adequate nitric oxide levels for optimal muscle, heart and circulation..

And Shifren ea 2008 showed that compared with oral CEE, TD E2 exerts minimal effects on CRP and the other inflammation and hepatic parameters – more adverse hepatic first-pass effects of oral HT as regards both cancer and cardiovascular disease. .

Thus, given that the higher the rate of breast and uterus proliferation the greater the risks in later life, sex hormone therapy and replacement in women (let alone men) should always be parenteral- the lowest dose to achieve the desired goal- be it feminization in Turner’s Syndrome; contraception; or postgonadopausal HRT in men or women.

The ill-informed reaction to the poorly planned Womens’  Health Initiative led to a massive fall in all HRT use.

MEMORY PROTECTION:

Yet abundant studies reviewed in this column the past two years show the incalculable benefits of appropriate balanced (E+P+T) in PMW.  No-where is this better shown than in neuroprotection especially against Alzheimer’s disease AD, in which- in eg  the Womens’ Health Initiative–  introduction  of oral xenohormones well after age 60years worsened the risk of AD, but  CEE  started soon after menopause greatly reduced AD risk.

University   Beijing has shown that women who have taken lowdose oral E2 0.5-1mg plus progesterone 0.5-2mg for 4 to 33yrs have  significantly less hippocampal atrophy;   similarly at Univ S California,  studies in AD-prone mice show that early oophorectomy worsens the AD pathology and behaviour changes, but this deterioration is better blocked by E2 + progesterone combined than by E2 alone.

Testosterone replacement is probably brain-protective in men;  it remains to be seen whether it adds  memory protection in women when combined with E+P. A  2006 British study of estrogen treatment in male to female transsexuals showed few and inconsistent changes in memory and cognition.

But a new Spanish study does show that when female-to-male transsexuals are treated with testosterone for 6 months, they show significant improvement in visual but not verbal memory.  And a new Swedish study shows that “The most positive effects of estrogen plus progestogen therapy concerning memory and urinary tract and vaginal complaints were found in women with the highest and/or moderate testosterone levels (P < 0.05).”

recent UK  MRC study shows the critical importance of optimal thyroid function in memory, since excess of either thyrotropin or thyroid hormone can be adverse.

And it has long been known that the more hypoglycemic episodes diabetics experience, the worse long-term memory.

Thus balance of  all three major sex hormones- estrogen, testosterone and progesterone, as well as insulin and the thyroid axis,  is  crucial in cognitive performance especially in women.

HORMONE CREAMS: for those who prefer creams to  pills, implants or injections, a major advantage is that  women  can start low with all three main sex hormones as appropriate, and titrate them individually upwards to tolerance or designated ceilings. Once optimal intake and levels of each have been attained, they can then if wished be combined, compounded.

CONCLUSION:

As this column discussed two weeks ago: mid- twentieth-century women now potentially live to double the age of those born in the early Victorian era; but increasing numbers undergo premature menopause and especially relative androgen deficiency due to  elective sterilization, hysterectomy, survival from cancer and radiotherapy, or increasing cancer risk from smoking, alcohol, suppressed menstruation due to birth control hormones, cortisone use eg for autoimmune diseases and transplantation, nuclear fallout or the feminization of nature .

They thus spend the second half of their lives post menopause, with increasing premature mortality and morbidity from diseases of hormone deficiency:   fattening and diabetes; heart and circulatory disease; muscle and bone frailty; arthritis; infections,  incontinence;  and worst of all, depression,  cancer  or loss of memory; and not least, loss of vital  sexuality. These are all largely avoidable by appropriate early and permanent non-oral balanced HRT and a blend of the other three-score other natural  supplements.

As Prof  Robert Greenblatt from Augusta  wrote in The Menopause Syndrome (Medcom Press)  in 1974, ” the menopause is a physiological endocrine hormone deficiency state. It is good practice to offset endocrine deficiency states by hormone replacement therapy to restore hormone balance”- whether in a teenager or a grandmother.

And Prof Emanuel  Schleyer-Saunders from London stressed in the same colloquium that even 35 years ago, half of all hospital beds were occupied by diseases of old age- obesity-diabetic-vascular, mental and malignant- which (as Masters and Grody had shown 20years earlier) are delayable by decades provided balanced parenteral permanent HRT is started early in menopause- which starts insidiously in the mid-forties if not earlier.

Whereas Masters and Grody in St Louis, and Gelfand in Quebec,  established this by long term injections of testosterone TT and estradiol E2  esters (which for decades have been available as a 20:1 mixture lasting 2 to 3 weeks), Schleyer-Saunders and then Whitehead and Studd  in London,  and Gambrell in Augusta, maintained this long term by pellet implants every few months.  Schleyer-Saunders showed with pellets that continuous balancing TT reduced the incidence of breakthrough bleeding from 20% on E2   alone , and 12% on E2 + progesterone P, to 8% on E2 + TT,  but only 5% on all three ie E2 + P + TT – with reduction in cancers. He generally used a dose of 25mg of each hormone, but (at a time when  women were far slimmer) 50mg E2 implant  in women post oophorectomy.

Yet MacLennan ea from the International Menopause Society now report that in Australia, as a result of the hysteria generated by the wrong Womens’ Health Initiative and Million Women Study reports (in which most women used oral xenoHT), only 12% of postmenopausal use hormone replacement.

Convenience should be the last factor considered. Unless balanced  lowdose mcronized estradiol, testosterone and progesterone are used orally  – since micronized particles largely  bypass  transhepatic absorption- there is no longer excuse for the risks of oral CEE,  progestins and similar hormone therapy with hepatic first pass adverse effects.  “Convenience” is no defense  against charge of negligence  when the patient develops major complications from oral sex hormones. So the patient who insists on oral hormones should sign an informed consent form that she has been warned,  but accepts the risks of the oral (as opposed to the physiological parenteral) regime.

All  women (and men) – especially with chronic or serious acute ill health – should thus be ensured  permanent  youthful sex hormone levels with appropriate physiological HRT that avoids both hepatic first pass metabolism and hormone excess/ imbalance. Traditional American industrial hormone therapy ( dominant the past 50 years due to the connivance of the FDA with it’s supporting drug industry) with oral xenohormones eg CEE, progestins and anabolic steroids cannot provide the physiological replacement required, that is ensured with titrated human hormones  in every other branch of endocrinology for the past generation.

It remains an indictment of American medicine and legislators that their Disease and Drug  Industry- the FDA and mainstream physicians-   put their  commercial interests ahead of  womens’ welfare   in making postmenopausal women the exception to the rule of  evidence-based medicine especially endocrinology. The most vulnerable group (after children)- the older women – are thus as always the main innocent victims of the FDA-led  Disease Industry’s  War on Humanity, the Black Mass of organized commercial Big-Pharma “medicine”- of which 13  USA firms in  about 2006 had half the world’s gross “medicines” turnover of ~ $600billion. Based especially  on womens’ ills and vulnerability- particularly cosmetics and cosmetic surgery, screening mammography and hysterectomy-  the Beauty/Disease Industry is thus truly a multi-$trilliondollar moneyspinner, disaster capitalism targeting women.

ANNUAL ETHICAL REVIEW: IS DIAGNOSTIC SCREENING WORTH IT UNLESS IT INCREASES HEALTHY SURVIVAL MEANINGFULLY?

A year since our last review–  which summarized studies till then- has anything changed?

Medically, “screening” is the search for a hidden disease in someone who has no known risk factors for or symptoms of disease. Apart from the far higher risk of all cancers in smokers, in non-smokers the commonest cancer is prostate cancer PRCA  – cancer causes  perhaps 24% of male deaths of which 1/10th are from PRCA; whereas breast cancer BRCA is the commonest  in women, but all cancers kill only 3% of women – 1/7 from BRCA; followed by colon cancer..

And of course screening is justified only if detection of an unexpected problem is going to make a significant difference. Certainly all the evidence is that detecting a silent PRCA in an otherwise well man makes no difference to his chances of dying from such cancer. It is also unclear whether the cost, radiation risk, bother of mammography, and about 5 unnecessary breast biopsies for each small cancer found, actually extend the woman’s lifespan, as opposed to waiting till the cancer is detected as a lump. Earlier detection may simply lengthen the lifespan spent living with known cancer.

Many men and women have a previously undetected incidental cancer at autopsy. And there is no point in screening if they will in any event not accept treatment for cancer- some women (whether from faith, fear or ignorance) choose to ignore the growing lump, accept natural disease progression, even though simple excision of a small breast lump can reduce the deathrate from clinical BRCA to below 5%, thus extend life by decades.

This contrasts with compulsory regular screening of the seemingly  well for eg overweight, glaucoma, hypertension (or cervix cancer in sex workers), where early detection and treatment of silent disease can respectively add years to health.

But risks of cancer are fairly commonly found in the history and lifestyle:  obesity and diabetes; occupation;  lifetime number of menstrual cycles, total intake of oral sex hormones, tobacco, alcohol etc; and especially family history of deaths under perhaps age 70years from one of the sexhormone related cancers (breast, prostate, endmetrium, ovary, colon).

Excluding women with such risk factors –who should be screened with far more conviction- this week a radiologist soberly publishes What is the point: will screening mammography SMG save my life? by calculating the life-saving absolute benefit of SMG  in reducing breast cancer mortality in women ages 40 to 65. By adjusting the SEER   Program 15-year cumulative breast cancer mortality to account for the separate effects of SMG  and improved therapy, they calculated the reduction in absolute death risk, and the survival percentages without and with screening.

RESULTS: The number needed to screen repeatedly is 1000/1.8, or 570. The survival percentage is 99.12% without and 99.29% with screening. The average benefit of a single SMG  is 0.034%, or 2970 women must be screened once to save one life. Less than 5% of women with screen-detectable cancers have their lives saved.

It is questionable (except for profit of the disease industry ie the economy) whether women should be frightened into having regular costly SMG by being told that “1 in 8 will get breast cancer”, or more truthfully  that – unless they have high risk factors- SMG will reduce their risk of dying from BRCA by 0.17% from 0.88% to 0.71%?

As regards the putative benefit of screening: it is the ABSOLUTE risk reduction number that matter to patients- not the relative 19% decrease in risk, since 19% of say 50% is an absolute significant  fall of perhaps 10%, whereas 19% of 0.88% is only 0.17% risk reduction over decades- hardly worth the cost and bother.

When attention should rather be focused on improving lifestyle and diet, and multisystem-protecting supplements:  vitamins, minerals and biologicals-  eg fish oil, coQ10, arginine, carnitine, chondroglucosamine, appropriate  hormones and herbs- which are known to reduce the major degenerative diseases (cancer; depression, vascular; lung; kidney; digestive; diabetes; arthritic; fracturing; and dementing), and common infections, and all-cause premature mortality, by half.

The latest SEER statistics 2001-2005 show that age-adjusted

deathrates in women for BRCA were 0.126%pa, and mortality 0.025%pa; and   in    men PRCA rates were 0.163%pa, mortality 0.026%pa.

All-cancer mortality in men was 0.23%pa of which 11% were from PRCA;

all-cancer mortality in women was 0.16%pa of which 12.5% were from BRCA.

Thus  while men get more PRCA, their absolute mortality  is the same as from BRCA in women; the respective deathrate relative to incidence from PRCA in men is 6.6% lower than from BRCA in women- BUT the mean age in women at 61yrs is 7years younger than PRCA in men, respective peak age at 60yrs 10 yrs younger than in men, with occurrence in women from age 20yrs compared to from 35yrs in men.

Hence women suffer BRCA – and body image disfigurement –  much younger than do men PRCA. But women with BRCA  do not have the physical urinary and erectile problems that  PRCA and it’s surgery cause in men.

Looking at the bigger picture of the CDC deathrates for 2005,

in men PRCA caused 0.02%pa out of total cancer deathrate of  0.2%pa ie 10% of all cancer deaths and 2.3% of all deaths (0.827%pa), compared to heart and all vascular disease causing 35% of all deaths;

in women BRCA   0.027%pa (same as diabetes rate)  out of total cancer deathrate of 0.18%pa ie 15% of all cancer  deaths and 3.1% of all deaths (0.825%pa); compared to heart and all vascullar diseases causing 36% of all deaths.

Colorectal cancer caused similar deathrate – 0.018%pa –  in men and women.

Thus breast and prostate cancers in USA cause only about 1/12 to 1/15th of  the deaths from the overwhelming cause of aging mortality-  heart and vascular disease!

The reality is that – even if there is no  family history  of fatal breast cancer- it is awareness, regular breast selfexamination that matters, and if a new pain or lump or tenderness or bleeding is found, prompt medical consultation that can nip a small cancer in the bud before it can spread.

Thus, rather than having men and women at average risk obsess about costly but low-yield (breast,  prostate  and colon) cancer screening, both adults and their healthcare providers should focus 10 times harder on dealing with the main underlying cause of premature cardio/vascular (and cancer and arthritic and immune) disease- increasing overweight leading to diabetes, obesity and the common degenerative problems. This is especially germane when better attention to diet, lifestyle and appropriate early prescription of preventative metformin and the scores of other supplements can halve the rates of diabetes, obesity and thus all the major common ageing diseases- including sudden death.

ndb