Polifarmacia segun el canandiense Colin Rose (www.procor.org)
One can argue the details of the cost/benefit of the Polypill ad
infinitum using whatever numbers one wishes but the real cost is
psychological not financial or physical. Even if the Polypill cost
nothing and had no physical side effects it is disaster waiting to
happen.
I predict that once the Wald and Law Polypill is in widespread use
they will have to add metformin to the mixture. Type 2 diabetes
secondary to obesity will become as common as hypertension.
Most of chronic diseases that kill in developed and developing
populations are due to lifestyle choices. Call it what you want but
this is an old-fashioned moral issue. In societies with almost
infinite choices in food, sex, mind-altering drugs, labor saving
machines, etc. we all have to make hundreds if not thousands of often
painful choices every day of our lives. What I would call Appetite,
the desire to have everything, which powers survival actions and
creativity, is infinite and potentially very destructive. Appetite
can never be satisfied. To quote Mick Jagger, "I can't get no
satisfaction." So real pleasure must come from the knowledge that one
has the power to control infinite Appetite.
Like Papal indulgences, drugs for lifestyle diseases like
atherosclerosis, obesity, DM2 and hypertension promote the illusion
that one can satisfy infinite Appetite with no destructive
consequences. The result is the pandemic of obesity and DM2.
Medicine is supposed to be a
profession but today has to a large extent been converted into a
marketing agency for drug and medical equipment peddlers. It is
almost embarrassing to be part of such a profession.
I have just attended the Canadian Cardiovascular Congress in
Vancouver. The Canadian Cardiovascular Society exists in its present
form because of the funding provided by "industry" at the Congress,
especially the "Grand Patrons", AstraZeneca, Bayer, Biovail,
Boehringer Ingelheim, Sanofi Aventis, Bristol-Myers Squibb and Merck
Frosst, Novartis, Pfizer, Roche and Servier. Drug advertising is
pervasive. Almost every speaker at the "industry" funded satellite
symposia has multiple connections with "industry" when they feel in
the mood to present their disclosures. Results of blinded controlled
studies of statins, CCB's, ACEI's and ARB's are presented and minute
differences in "relative risks" and subgroups are argued about.
Here's an example:
Advances in Cardiology (supported by Merck Frosst, Pfizer and Sanofi
Aventis)
Debate 1: The Best Combination for Primary Prevention of CVD is:
Statin and CCB, George Honos, MD
Statin and ACEI, Eva Lonn, MD
Why the argument? The Polypill will have all three anyway.
In my opinion it is as unethical to experiment with drugs for
atherosclerosis, hypertension and DM2 on a population living an
atherogenic, obesogenic, diabetogenic, hypertensogenic lifestyle as
it is to experiment with with cholera drugs in a population with
epidemic cholera when the source of the contaminated water is known.
Many fewer such studies would be done and many less drugs would get
prescribed in lieu of lifestyle advice if doctors were forbidden to
have any financial connection to "industry."
Dr. Graziano asks why children are getting obese if they are not
taking pills for lifestyle diseases. Well, neither are pets but cats
and dogs are also having an obesity epidemic. Children and pets adopt
the same habits as adults in the household.
With regard to the incidence of obesity in Britain since the
introduction of BTC statins, there is lots of information on the net
if one cares to look. Here is a quote from the Manchester Evening News,
Friday, 25th August 2006
Britain's obesity timebomb
BRITAIN is facing an obesity timebomb, with new figures revealing an
escalation of the crisis.
The alarming Department of Health statistics predict that nearly a
third of the population will be obese within the next four years -
and that by 2010 more than 14m people will be dangerously overweight.
Thousands are expected to suffer diseases like cancer, heart disease
and Type 2 diabetes, with the cost of obesity to the NHS rising well
beyond the current £1bn.
Over the past three years, obesity among adults has risen by 38 per
cent. By 2010, there will be 1.7m obese children and almost 13m obese
adults.
A total of two per cent of girls and 19 pert cent of boys aged two to
15 will be regarded as chronically overweight. The projections have
been made as millions are poured into education on reading food
labels and exercise.
And another from the Evening Standard,
THREAT TO PALLBEARERS AS BRITAIN'S OBESITY RATE SOARS
09.10.06
The tradition of pallbearers carrying coffins at funeral services is
facing a threat from Britain's soaring obesity problem.
An increased number of seriously overweight people has meant health
and safety regulations have restricted usual practices at more and
more funeral services.
With the combined weight of corpse and casket regularly exceeding 35
stone, funeral directors are having to use trolleys and lifting
equipment instead of professional pallbearers and family mourners.
Such is the concern about the consequences of workplace injuries that
risk assessments must be routinely carried out where the combined
weight of a corpse and coffin could be a problem.
John Weir of the National Society of Allied and Independent Funeral
Directors, said: 'Even five years ago this was not a problem. It was
rare to have a coffin that couldn't be physically carried. Now it's
every single week. Health and safety regulations prevent us from
legally carrying coffins in many cases.
'Funeral Directors are more aware of their obligations to staff in
terms of what they can carry.'
Until recently coffins were made 22 to 24 inches wide, now 26 in is
standard and many companies use over-size 40 inch wide coffins. With
heavy oak coffins weighing around eight stone, funeral directors
sometimes ask mourners to sign a disclaimer before bearing the weight.
The most common solution is to replace humans with a wheeled bier
trolley - which has been used in funerals since Victorian times.
Mr Weir, boss of a Kent-based firm, said: 'The overriding concern of
funeral directors is that the funeral goes ahead with dignity.
There's nothing less dignified than the sight of bearing staff
struggling with excess weight.'
Oversized coffins have become commonplace in the United States. A US
firm specialising in manufacturing coffins for obese people estimates
around 300 oversized coffins are sold everyday compared to about
three 15 years ago.
Known disasters have included the funeral firm who couldn't get a
casket out the door, the coffin that buckled with the weight of the
body while on a stand during the service and the coffin that wouldn't
close.
Some families are being forced to buy two plots and pick up trucks
are being used to transport large coffins.
Last year a crematorium in Bath, Somerset, spent thousands of pounds
installing large cremators to cater for the increasing number of
oversized coffins. Staff were regularly having to turn grieving
families away because relatives were too big to be cremated at the site.
Adult obesity rates in the UK have almost quadrupled in the last 25
years, with 22 per cent obese and three-quarters overweight.
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Colin Rose
http://www.panaceia-or-hygeia.com