RESUMO
Much has been written about the deplorable state of American health care, but rarely with the wealth of historical and political information packed into Peter Swenson's Disorder: A History of Reform, Reaction, and Money in American Medicine (2021). In this meticulously researched and comprehensive study of the role of organized medicine, particularly the American Medical Association (AMA) and affiliated state and county medical societies, Swenson provides detailed insight into the AMA's political evolution from a force advocating progressive reforms to a protective guild backed by powerful economic and ideological interests. Swenson addresses the conflicts leading to and arising from these movements, always with an eye on the profession's failure over the last century to fulfill its implicit social contract. Swenson describes the American medical disorder without fear or favor, including a public health system in disarray, defective government regulation of drugs, unchecked and concealed commercial influence on medical research, publications, and clinical guidelines. Swenson's hope is clear: that a progressively reformed AMA-combined with a broad coalition of concerned citizens and legislators-will lead the medical profession back to its rightful mission.
Assuntos
Pesquisa Biomédica , Saúde Pública , Estados Unidos , Humanos , Medo , Sociedades Médicas , RedaçãoAssuntos
Hemorragia Pós-Parto , Tromboembolia Venosa , Consenso , Feminino , Humanos , Segurança do Paciente , GravidezAssuntos
Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/epidemiologia , Humanos , Mortalidade , Doenças Musculares/induzido quimicamente , Doenças Musculares/epidemiologia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Risco , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
BACKGROUND: Delivery of a pharmacologically effective drug dosage to a target tissue is critical. Barrett's epithelia are a unique challenge for drug delivery of orally administered zinc due to rapid transit down the esophageal lumen, incomplete absorptive differentiation of these epithelia, and the use of proton-pump inhibitor drugs abrogating intestinal uptake of supplemental zinc. METHODS: Barrett's esophagus patients were administered oral zinc gluconate (26 mg zinc twice daily) for 14 days prior to biopsy procurement. Barrett's biopsies were analyzed for total zinc content by atomic absorption spectroscopy and by western immunoblot for cellular proteins known to be regulated by zinc. RESULTS: Cellular levels of both the Znt-1 transport protein and the alpha isoform of PKC were over 50% lower in the zinc treatment group. CONCLUSION: Oral zinc administration can result in effective delivery of zinc to Barrett's epithelia with resulting effects on intracellular signal transduction.
Assuntos
Esôfago de Barrett/tratamento farmacológico , Suplementos Nutricionais , Sistemas de Liberação de Medicamentos , Esôfago/efeitos dos fármacos , Gluconatos/administração & dosagem , Administração Oral , Adulto , Idoso , Esôfago de Barrett/metabolismo , Esôfago de Barrett/patologia , Biópsia , Western Blotting , Proteínas de Transporte de Cátions/efeitos dos fármacos , Proteínas de Transporte de Cátions/metabolismo , Esôfago/metabolismo , Esôfago/patologia , Feminino , Gluconatos/farmacocinética , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Proteína Quinase C-alfa/metabolismo , Transdução de Sinais/efeitos dos fármacos , Espectrofotometria Atômica , Fatores de Tempo , Resultado do TratamentoAssuntos
Acesso à Informação , Ensaios Clínicos como Assunto/estatística & dados numéricos , Ensaios Clínicos como Assunto/normas , Medicamentos sob Prescrição/uso terapêutico , Viés de Publicação , Sistema de Registros , Interpretação Estatística de Dados , Revelação , Indústria Farmacêutica/economia , Humanos , Programas Obrigatórios , Uso Off-Label , Propriedade , Medicamentos sob Prescrição/efeitos adversos , Reprodutibilidade dos Testes , Resultado do Tratamento , Estados Unidos , United States Food and Drug AdministrationRESUMO
BACKGROUND: Among the recently reported cholesterol-lowering drug trials, the JUPITER (Justification for the Use of Statins in Primary Prevention) trial is unique: it reports a substantial decrease in the risk of cardiovascular diseases among patients without coronary heart disease and with normal or low cholesterol levels. METHODS: Careful review of both results and methods used in the trial and comparison with expected data. RESULTS: The trial was flawed. It was discontinued (according to prespecified rules) after fewer than 2 years of follow-up, with no differences between the 2 groups on the most objective criteria. Clinical data showed a major discrepancy between significant reduction of nonfatal stroke and myocardial infarction but no effect on mortality from stroke and myocardial infarction. Cardiovascular mortality was surprisingly low compared with total mortality-between 5% and 18%-whereas the expected rate would have been close to 40%. Finally, there was a very low case-fatality rate of myocardial infarction, far from the expected number of close to 50%. The possibility that bias entered the trial is particularly concerning because of the strong commercial interest in the study. CONCLUSION: The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.
Assuntos
Anticolesterolemiantes/uso terapêutico , Doenças Cardiovasculares , Colesterol/sangue , Fluorbenzenos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Quimioterapia Combinada , França/epidemiologia , Humanos , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Rosuvastatina CálcicaAssuntos
Conflito de Interesses , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Apoio à Pesquisa como Assunto , Celecoxib , Inibidores de Ciclo-Oxigenase/efeitos adversos , Indústria Farmacêutica/economia , Ética em Pesquisa , Humanos , Lactonas/efeitos adversos , Padrões de Prática Médica/estatística & dados numéricos , Pirazóis/efeitos adversos , Apoio à Pesquisa como Assunto/economia , Apoio à Pesquisa como Assunto/ética , Sulfonamidas/efeitos adversos , Sulfonas/efeitos adversosRESUMO
We often think of health policy and health services research as offering solutions to cost, quality, and access problems. Many of us see health policy as simply ineffective. But any activity that has the power to cure can also do harm. Is it possible that the health policy enterprise has contributed to the very problems it has been attempting to eliminate? We argue that it has. Reasonable assumptions have led to a series of solutions that have provided political cover for those vested in the status quo. This process is nonpartisan, with those of us on the left and the right unintentionally and inadvertently contributing to the problems we are so committed to solving.