Two Changes in content coming up

1. The cholesterol myth.  Numerous critics have pointed out that cardiovascular disease is not caused by higher levels of blood cholesterol or fats.  Pharma promotes the cholesterol myth and ignores the major causes.

2. Major cause of cardiovascular disease is pathogens living within the middle layer of artery walls.  It initiates the immune response which involves LDL, HDL, and white blood cells.  Reactive chemicals such as simple sugars and carbon monoxide can potentiate the process resulting in the formation of plaque within the artery walls.

    

For confirmation from journal articles on primary role of infective agent enter into http://scholar.google.com/ terms such as bacteria + atherosclerosis or go to http://healthfully.org/rl/id8.html and id9  for collection of articles

For confirmation of cholesterol myth enter into http://scholar.google.com/ or http://www.amazon.com/ cholesterol myth, or go to http://healthfully.org/rl/id5.html for collection of journal articles. 

It sure has become big business: standard treatment following an heart attack (MI) costs $109,000* per year for just for the 3 drugs—none of which are worth the side effects, let alone their price.   Remember the marketing department of the drug company are as standard operating procedure manipulating the results to create a positive bias on an average of about 30%,  The doctors all have conflicts of interest, and the journal does not see the raw thus preventing a meaningful peer review.  The claim of significantly better results based on a 2% greater compliance than with those who had a copay, this is deceptive.  In other words don’t rely on the results, just consider significant the cost for what, in my father’s day (1953) was cost about $25 a year (he had nitroglycerin as his only medication, and he lived 23 years from his first major MI—nearly killed him.  And if you wonder why there is poor compliance (under 50%);  the two major reason are a skepticism about the integrity of the pharmaceutical industry and their sales people the primary care givers, and secondly the side effect.  That side effects are not even mentioned is one more indication of the marketing department controlling content.    

Revascularization is the restoration of the blood circulation of an organ or area, achieved by unblocking obstructed or disrupted blood vessels or by surgically implanting replacements. 

Full Coverage for Preventive Medications after Myocardial Infarction

Niteesh K. Choudhry, M.D., Ph.D., Jerry Avorn, M.D., Robert J. Glynn, Sc.D., Ph.D., Elliott M. Antman, M.D., Sebastian Schneeweiss, M.D., Sc.D., Michele Toscano, M.S., Lonny Reisman, M.D., Joaquim Fernandes, M.S., Claire Spettell, Ph.D., Joy L. Lee, M.S., Raisa Levin, M.S., Troyen Brennan, M.D., J.D., M.P.H., and William H. Shrank, M.D., M.S.H.S. for the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) Trial

Background

Adherence to medications that are prescribed after myocardial infarction is poor. Eliminating out-of-pocket costs may increase adherence and improve outcomes.

Methods

We enrolled patients discharged after myocardial infarction and randomly assigned their insurance-plan sponsors to full prescription coverage (1494 plan sponsors with 2845 patients) or usual prescription coverage (1486 plan sponsors with 3010 patients) for all statins, beta-blockers, angiotensin-converting–enzyme inhibitors, or angiotensin-receptor blockers [blood pressure meds]. The primary outcome was the first major vascular event or revascularization. Secondary outcomes were rates of medication adherence, total major vascular events or revascularization, the first major vascular event, and health expenditures.

Results

Rates of adherence ranged from 35.9 to 49.0% in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group (P<0.001 for all comparisons). There was no significant between-group difference in the primary outcome (17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group; hazard ratio, 0.93; 95% confidence interval [CI], 0.82 to 1.04; P=0.21). The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group (21.5 vs. 23.3; hazard ratio, 0.89; 95% CI, 0.90 to 0.99; P=0.03), as was the rate of the first major vascular event (11.0 vs. 12.8; hazard ratio, 0.86; 95% CI, 0.74 to 0.99; P=0.03).* The elimination of copayments did not increase total spending ($66,008 for the full-coverage group and $71,778*** for the usual-coverage group; relative spending, 0.89; 95% CI, 0.50 to 1.56; P=0.68). Patient costs were reduced for drugs and other services (relative spending, 0.74; 95% CI, 0.68 to 0.80; P<0.001).

Conclusions

The elimination of copayments for drugs prescribed after myocardial infarction did not significantly reduce rates of the trial's primary outcome. Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs. (Funded by Aetna and the Commonwealth Fund; MI FREEE ClinicalTrials.gov number, NCT00566774.)

Supported by unrestricted research grants from Aetna and the Commonwealth Fund to Brigham and Women's Hospital.

Dr. Choudhry reports receiving consulting fees from Mercer Health and Benefits and grant support from CVS Caremark; Dr. Glynn, receiving consulting and lecture fees from Merck and grant support from AstraZeneca and Novartis; Dr. Schneeweiss, receiving consulting fees from WHISCON and grant support from Pfizer and Novartis; Ms. Toscano, Dr. Reisman, Mr. Fernandes, and Dr. Spettell, being employees of and having an equity interest in Aetna; Dr. Brennan, being an employee of, having an equity interest in, and receiving board membership fees from CVS Caremark; and Dr. Shrank, receiving consulting fees from United Healthcare and grant support from CVS Caremark and Express Scripts.

*  An accurate estimate of cost is not possible given the sketchy information provided.  But assuming that the rate of compliance was an average of the 35.9 and 49% compliance for the 3 drugs, and that the cost of each are about the same, then the average compliance for a drug was 42.45% or that 57. 55% of the time the drugs weren’t taken.  Secondly assuming that the drug costs were an average of $68,893.  Assuming 100% compliance 1.5755 ($68,893) = $108,541 rounded off to $109,000 per year for full compliance.

**this is double talk.  Not only are the standard not brought out, for major vascular events (which is obvious something other than MI), and this is paired with revascularization.  Thus the 4% higher compliance group has paired a good thing increasing blood flow (possible to the heart muscle) is paired with an adverse event, “vascular events”.  The normal pattern would be two good things such as fewer MIs and fewer strokes; not a good and bad event.    

*** Why aren’t the total costs of the drugs the same for both groups?  Note that those with copay are charged more than those with full coverage.  The copay group is charged $5,570 more which 8.74%.  This is reason to expect a kick-back to the participating parties taken from the extra which of those who have a copay.    

“Now, with help from the dissemination of quality metrics, cost-saving medications such as beta-blockers, aspirin, and angiotensin-converting–enzyme (ACE) inhibitors are nearly universally prescribed to eligible patients after myocardial infarction,²,³”  from another article in the same issue of NEJM.  One reason for giving aspirin besides that it works, is that if there is a stomach bleed, aspirin is blamed.  At the low dose of under 100 mg, it doesn’t cause stomach bleeds.