December 28, 2012 | 4:46 pm

On the Passage of Time

Posted by Albert Fuchs, M.D.

Follow me on or

Sunrise. Photo credit:
Wikimedia Commons

The sun will come up tomorrow.
– Little Orphan Annie

But in a trillion tomorrows the sun will become
a red giant and extinguish all life on earth.
– astronomers

If you’re reading this, you’ve completed another loop around the sun. Congratulations.

Marking space is easy. Walls, fences, lane dividers, buoys, flags, are all ways of communicating that the space over there is different than this space over here. Marking time is harder. We need holidays, calendars, events to remember that what comes after is different than what came before. While we can revisit places, we can’t revisit times.

So as the rightmost digit on the calendar is about to be incremented, it’s a good time to reflect on the successes and the setbacks of 2012 and to make realistic goals for 2013. The only thing about 2013 about which I am certain is that we’ll only get to do it once.

I wish us all a prosperous, healthy, and joyous 2013!

Learn more about time:

Dave Brubeck, one of the greatest Jazz composers ever, died in 2012. Here is a link to his best known song, from the album Time Out, which was a collection of experiments with different time signatures.
Dave Brubeck Quartet – Take Five (5 minutes)

How is it that the past is so different from the future? Why can we remember 2012 but not 2013 (at least yet)? Why can’t you uncook an egg or unburn a match? Those with a background in science know that the answer relates to the Second Law of Thermodynamics. I’ve seen no better discussion of this fascinating question targeted to a general audience than the following lecture by Richard Feynman.
Richard Feynman – The Character of Physical Law -Lecture 5 -The Distinction of Past and Future (46 min)

Lucius Annaeus Seneca: On the Shortness of Life

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

December 21, 2012 | 1:59 pm

Niacin: Ineffective, and Now with Fewer Side Effects!

Posted by Albert Fuchs, M.D.

Photo credit:
Wikimedia commons

I haven’t written about niacin for over a year, and like a misunderstanding of the Mayan calendar that won’t go away, niacin is in the news again this week.

You can catch up on the old news by reading my previous posts (links below) but here’s the story in a nutshell. People with high levels of a cholesterol molecule called LDL tend to have more strokes and heart attacks than people with normal LDL levels. People with low levels of a cholesterol molecule called HDL tend to have more strokes and heart attacks than people with normal HDL levels. (Does that mean that LDL causes strokes and heart attacks or that HDL prevents strokes and heart attacks? Nobody knows.) We've long known that taking niacin raises HDL and lowers LDL. That should be good, right? And in fact a study called the Coronary Drug Project in the 60s and 70s showed that in patients with a previous heart attack, taking niacin modestly reduced the risk of another heart attack.

More recently, many other medications have been proven to prevent strokes and heart attacks – aspirin, statins (a family of cholesterol reducing medicines), and beta blockers (a family of blood pressure medicines). These medicines are now in widespread use. Statins especially have very solid evidence that they greatly decrease the frequency of strokes and heart attacks, and now that some of them are available generically they are used extensively. Last year, the AIM-HIGH trial tried to discover whether patients with a history of cardiovascular disease and low HDL had better outcomes by taking niacin with a statin than by taking a statin alone. They didn't  The rates of strokes and heart attacks were the same in both groups, strongly suggesting that in the age of statins, niacin has no additional benefit.

Now, when faced with a medication that has no benefit, I typically decide not to prescribe it, but not the folks at Merck. They were thinking “How can we decrease the side effects?” Why it would be valuable to decrease the side effects of a medicine without benefit is a mystery that only Mayan astronomers are likely to solve. In any case, the most common and bothersome side effect of niacin is facial flushing, so Merck came up with a tablet in which they combined niacin and a second drug, laropiprant, which prevents the flushing. This combination medicine, called Tredaptive, has been in use in Europe since 2007.

A large trial designed to win FDA approval for Tredaptive ended this week. The results won’t be formally published for some time, but Merck has already released some important tidbits. The study randomized over 25,000 patients to Tredaptive and simvastatin or to simvastatin alone. The patients were monitored for over four years. There were no differences in rates of strokes or heart attacks between the groups, but the Tredaptive group had an increase of a “serious adverse event” the details of which Merck has yet to release. In an unusual move, Merck has asked European physicians not to start new patients on Tredaptive.

This new finding should throw a wet blanket on the few remaining niacin enthusiasts. Niacin use has declined since the AIM-HIGH study and now should decline further. It has no benefit in the vast majority of patients who can tolerate statins.

Learn more:

Why Merck's Niacin Failure Will Scare Drug Researchers (Forbes)
Merck Says Niacin Drug Has Failed Large Trial (New York Times)
Merck: Niacin Drug Mix Fails To Prevent Heart Attacks, Strokes (NPR Shots)

My previous posts about niacin:
Niacin Much Less Helpful in the Age of Statins
Niacin Does Not Prevent Strokes or Heart Attacks

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

December 7, 2012 | 5:10 pm

Flu Season Hits Earlier than in Recent Years

Posted by Albert Fuchs, M.D.

Flu incidence by week
(CDC)

This year’s flu season seems to be starting earlier than usual and is getting more intense by the week. The Centers for Disease Control (CDC) reports in its weekly summary of flu surveillance that flu cases are increasing across the country. California still is showing only sporadic flu activity, but 8 other states report widespread activity and 15 others report regional activity.

The CDC reminds us that it’s not too late to protect yourself and those around you by getting a flu shot. The vaccine is recommended for everyone over 6 months of age. And the CDC also has other helpful suggestions for preventing flu transmission. If you’re sick, stay home and limit contact with others. Avoid touching your eyes, nose, and mouth. Cover your coughs and sneezes with a tissue. And wash your hands frequently.

I've seen no randomized studies suggesting that lighting candles, singing songs, or eating latkes decreases transmission of flu, but I recommend it anyway. Happy Hanukkah!

Learn more:

Unusually Early Flu Season Intensifies (NPR Health)
Situation Update: Summary of Weekly FluView (CDC)
Google Flu Trends for Los Angeles
Key Facts About Seasonal Flu Vaccine (CDC)
CDC Says “Take 3” Actions To Fight The Flu (CDC)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment