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Lemmings Die Young

I know this is a provocative and potentially cruel title, but I'm using the same tactic used to convince 80% of the American population to take an untested or unproven jab. The concept is that of "adrenal imprinting."



"Emotionally significant experiences tend to be well remembered.1,2 We know this from personal experiences as well as from extensive research findings. Significant experiences such as birthdays, graduation ceremonies, or the loss of a loved one typically leave lasting and vivid memories.


Findings of experimental studies indicate that people have good recollections of where they were and what they were doing when they experienced earthquakes3 or witnessed accidents.4 Similarly, a rat remembers the place in an apparatus where it received a footshock or the location of an escape platform in a tank filled with water.5,6


Such memory enhancement is not limited to experiences that are unpleasant or aversive. Pleasurable events also tend to be well remembered



Fear can create a strong and lasting imprint. Have you encountered a lion? If you survived, it is an event you will never forget. Fear of dying from SARS-CoV-2 created the imprint that eventually led to the decision to become "protected" from death. Certainly we were overwhelmed with messages from the media about the risks of this toxin. However, it was the imprinting that put many over the top.


This is not a "blame game." The physiological changes that come with fear are a natural survival response. However, confronting a lion in person is real, whereas TV / social media (should be called gossip media) may not be.


How old is the expression, "I'm from the government, I'm here to help." Yet most of us know this is NOT true - yet, in a state of panic, response overrides reason.




Ronald Reagan once said “The nine most terrifying words in the English language are: I’m from the Government, and I’m here to help.”





WHAT IS ONE TO DO?


Seek REAL evidence - not gossip.


 

During my travels, I listen to a lot of talks. One stuck out. It was by Dr. Peter Gøtzsche, founder of the Cochrane Collaboration. I quoted Cochrane in a previous blog on blood pressure medication and the elderly (see below).


The Cochrane Collaboration used to be the absolute "go to" resource for evidence in medicine. Sadly, they to, are being corrupted to some degree. However, today, it is still the best we have. I intend to blog on Cochrane finding over the next year. Today, however, I highly recommend you watch this video by Dr. Gøtzsche as all of us seek objective, evidence-based information on the practice of medicine.



Where does the title of this blog come from, specifically the term "lemmings?" It is not just about the jab - it IS about the taking of ANY drug.


I am on the science and medical advisory committee the Insurance Collaborative to Save Lives (ICSL). This group is working to develop a program to reduce "sudden" early death. Indeed, the jab has resulted in a substantial increase in early death ACROSS ALL AGES. As part of the work of the ICSL, we have studied biomarkers that indicate a high risk of dying young or suddenly. Those markers included the usual suspects used in functional and integrative medicine including: CRP, D-dimer, NT-proBNP, WBC, and other pro-inflammatory markers.


What have we, the ICLS, NOT looked at? The correlation between early death and the number of pharmaceutical drugs the person is taking. Granted, the correlation may not be strong in the young who "died suddenly," or suffer from "long-haul" but we don't know for sure. However, the excess mortality is greater in the elderly who take more drugs. Regardless, my guess is that the correlation between the number for pharmaceuticals taken and the risk of early death is a stronger indicator of risk than the biomarkers. The biomarkers are also elevated, but the drugs deliver the "death blow."


In my next blog I will show the relationship between the reliance of modern medicine and longevity. This is a relationship I have been showing for over a decade using OECD data.

 

Let's return to the "trust" concept. Dr. Trempe opened my eyes 20 years ago when he told me that, in 1980, the pharmaceutical industry was allowed to participate in medical school education. In my book, "The End of Alzheimer's," I wrote about the findings of the American Medical Student Association. Here is an excerpt.


Drug Companies Penetrate Curriculum at Major Medical Schools


Interestingly, the interactions between drug companies and medicine appear most involved at the highest levels of academia and medical education. An article titled, “Harvard Medical School in Ethics Quandary,” in the New York Times by Duff Wilson in 2009 sheds light on this conundrum.


According to the article, at a first-year pharmacology class at Harvard Medical School, a student grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects. A little research by the student revealed the professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments. This finding led the student to question the integrity of his education from Harvard, often thought of as the premier medical school in the world.


“I felt really violated,” a student said, as quoted in the article. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”


Some Harvard Medical School students and a few faculty members started a campaign to stop outside influences in their classrooms and laboratories, as well as in Harvard’s 17 affiliated teaching hospitals and institutes. They say they are concerned that the same money that helped build the school’s world-class status may in fact be hurting its reputation and affecting its teaching.


The American Medical Student Association gave Harvard a grade of F based on how well medical schools monitor and control drug industry money. Harvard Medical School’s peers received much higher grades, ranging from the A for the University of Pennsylvania, to Bs received by Stanford, Columbia, and New York University, to a C for Yale. An unofficial excuse came from Harvard claiming the problem occurred because its teaching hospitals are not owned by the university, complicating reform because the dean is fairly new and his predecessor was such an industry booster that he served on a pharmaceutical company board, and because a crackdown, simply put, could cost it money or faculty.


The Harvard students have already secured a requirement that all professors and lecturers disclose their industry ties in class, a blanket policy that has been adopted by no other leading medical school. One Harvard professor’s disclosure in class listed 47 company affiliations.


The students at Harvard leading the charge against drug company indoctrination say they worry that pharmaceutical industry scandals, including some criminal convictions, billions of dollars in fines, proof of bias in research, and publishing and false marketing claims impact their future ability to serve patients. These types of activities have cast a bad light on the medical profession.


The school said it was unable to provide annual measures of the money flow to its faculty beyond the $8.6 million that pharmaceutical companies contributed last year for basic science research and the $3 million for continuing education classes on campus. Most of the money goes to professors at the Harvard-affiliated teaching hospitals, and the dean’s office does not keep track of the total.


Harvard Medical faculty members receive tens or even hundreds of thousands of dollars a year through industry consulting and speaking fees. Under the school’s disclosure rules, about 1,600 of 8,900 professors and lecturers have reported to the dean that they or a family member had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizer and 130 with Merck. The rules, though, do not require them to report specific amounts received for speaking or consulting, other than broad indications like “more than $30,000.”


Dr. Jean Haddad wrote an interesting paper that was published in the San Francisco Medical Society website. It was titled, “The Pharmaceutical Industry's Influence on Physician Behavior and Health Care Costs.”


“The development of new drugs and therapies is responsible for improving health and longevity. Yet, these improvements in health care have been accompanied by a dramatic increase in cost. The National Institute for Healthcare Management found that U.S. spending on prescription drugs went from $111.1 billion to $131.9 billion in one year, an increase of $20.8 billion (18.8 percent). The bulk of the increase was due to spending on a relatively small group of drugs. Increases in the sales of 23 drugs accounted for 50.7 percent of the 20.8 billion. The NIHCM concluded that the overall increase in prescriptions and especially the shift toward use of costlier and newer drugs. These are the drugs, statistically, that are causing the most harm.”





 


Here is my reference to the Cochrane Collaboration wrt blood pressure.


The elderly make up of majority of the population on BP drugs. However, they are ubiquitous across all ages. Here are a couple of studies that suggest the elderly are NOT in need of BP drugs most of the time.



Key results

  • We found that stopping antihypertensive medications is possible in older adults.

  • Most of the older people in the discontinuation groups did not need to restart their medication.


We found low certainty of evidence that stopping antihypertensive medication increased blood pressure by a small amount.


We found low or very low certainty of evidence that stopping blood pressure medications did not increase the risk of having a heart attack, stroke, hospitalization, or death.


We found very low certainty of evidence that stopping blood pressure medications did not increase the risk of adverse events and may resolve side effects, but this was not reported well, and so we were unable to draw conclusions.


Certainty of the evidence

We rated the certainty of the evidence using four levels: very low, low, moderate, or high. High certainty evidence means that we are very confident in the results. Very low certainty evidence means that we are very uncertain about the results. We judged the certainty of evidence as very low and low.


Conclusion

It may be safe to stop antihypertensive medications in older people who are taking the medication for high blood pressure or primary prevention of heart disease.

 

Have you had any concerns about an older person falling, or being at risk for a broken hip?


A new clinical research study relevant to millions of older adults was just featured in the news.


The study, completed by a team of geriatrics researchers at Yale, found that in older adults aged 70 or older, taking blood pressure medication was linked to a higher risk of serious falls. (Serious falls as in, falls that caused an ER visit for a fracture, a dislocated joint, or a brain bleed. Serious stuff indeed!)


So, if the person you care for has a diagnosis of hypertension, and if you’ve had any concerns regarding falls or near-falls, these study results should be of interest to you.

In this post, I’ll review the key results of this study. Then I’ll tell you what I think are the most important practical take-aways for family caregivers.


This post will also include some practical tips to help you minimize the risk of your loved one experiencing a serious fall.


Key results of the high blood pressure medications and falls study.


One of the many good things about the study is that it used the Medicare records of a “real-world” group of 4961 people aged 70 or older.  (This is important because many clinical trials of BP medication are done with patients recruited specifically for the study; there are advantages to this but it means that often patients in clinical trials are healthier than the aging adults that you and I are caring for.)


To be included in this “real-world” study, the patients had to have a diagosis of high blood pressure, they had to be living at home or in assisted-living, and they had to be in Medicare fee-for-service (no Medicare Advantage patients).

The researchers then examined three years worth of these patients’ Medicare records. Here’s what they found:

  • Overall, 9% of these older people experienced a serious fall injury.

  • When people were classified based on how much BP medication they were taking, the percentages of aging adults having a serious fall within 3 years were:

  • No medication: 7.5%

  • Moderate-intensity BP medication: 9.8%

  • High-intensity BP medication: 8.2%


Next the researchers used some statistical adjustments, to compare older adults with similar levels of illness burden. (It’s important to do this adjustment, because otherwise it could be that some people have no BP medication because they are so sick and frail that doctors have stopped their medications.) In this adjusted group, the percentages of older adults having a serious fall over 3 years were:

  • No medication: 7.1%

  • Moderate-intensity BP medication: 8.6%

  • High-intensity BP medication: 8.5%


The researchers also found that in those people who’d had a serious fall injury within the previous year, being on BP medication was linked to an especially high chance of another serious fall.


What you should take away from this study

I consider this study very important, because most clinical research focuses on benefits of medication, rather than studying the potential harms and downsides of medication. It’s probably not a coincidence that the main author is a geriatrician; we tend to feel that a little goes a long way when it comes to medications in aging adults!


Key take-aways for family caregivers:

  • Serious falls are a fair possibility in all older adults aged 70+. Over 3 years, 9% of these Medicare patients had a fall involving a fracture, a dislocation, or a brain bleed. It’s probably reasonable for you to assume that your loved one has at least a roughly 10% chance of a serious fall within a few years. This risk is higher if your loved one has already had a serious fall.

  • Consider learning practical approaches to reducing fall risk in your loved one. Along with learning to be careful with medications, there is lots more that you can do! Visit our fall prevention topic page to see all our articles on this topic.

  • Consider a plan or system to call for help in the event of a fall. This is especially important for those independent older adults who live alone! Last year I saw a patient who lay at home with a broken hip for 2 days before he was found 🙁

  • Home sensors and/or a personal emergency response system can help alert a care circle when an older person falls.


  • Being on blood pressure (BP) medication raises the risk of a serious fall. This doesn’t mean your loved one shouldn’t take any medication for high BP. But it does mean that you should be thoughtful about weighing the benefits and the risks, and you probably want to aim for the lowest doses possible.  In my experience, regular doctors tend to not think of the risks of BP medications in aging adults. So here are some specific things YOU can do:

  • Be careful if your loved one’s BP is often below the new recommended target of 150/90. Read “What the New Blood Pressure Guidelines Mean for Older Adults” for more info.

  • Ask the doctors to help you understand how much benefit to expect from the BP treatment. Note that often the expected chance of benefit (e.g. avoiding a stroke or heart attack) is about the same as the risk of harm that was found in this research study.


Lewis: Don't expect an answer other than "take the damn BP meds and stop bothering me!"


  • Seniors who’ve had a previous serious fall are at extra high risk. Be extra careful about blood pressure and over-treatment if your loved one has already had a serious fall. These are the older adults for whom it’s most important to make sure that they aren’t on more medication than is absolutely necessary.

  • Know that in general, the most benefit from treating high blood pressure in seniors comes from getting a systolic blood pressure (SBP; that’s the top number that a monitor reports) from 170 or higher, down to 140s-150s.

  • Once elderly people are treated to a SBP below 140, the chance of harm can easily become bigger than the chance of benefit.

  • Get a home blood pressure machine if you’re concerned about falls and your loved one is on medication. Don’t just leave it to the doctors to monitor things and take action. When properly done, home BP measurements can be more accurate than occasional office measurements, and can lead to better care.




 

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