Invasive treatment not better than medical management for non-ST MI.

A randomized controlled trial published in the Lancet showed no benefit from early invasive treatment for non-ST elevation MI. Although it's true that they experienced fewer symptoms of angina, they did experience more MI's than their piers. This study seems to indicate that early invasive treatment in these cases is not indicated.

clipped from www.aafp.org Initial data indicated that routine invasive therapy was more effective than selective invasive treatment in reducing subsequent major cardiovascular events. More recently, large trials with up to five years' follow-up have had contrasting results. The researchers enrolled 1,200 patients 18 to 80 years of age between 2001 and 2003. Patients were randomly assigned to receive early invasive therapy or initial medical management with intervention only if clinically indicated...cumulative three-year results for the primary composite end point (death, recurrent myocardial infarction, or hospitalization) were 30 percent in the early invasive group and 26 percent in the selective intervention group (P = .09). The authors conclude that early invasive treatment did not provide better outcomes over four years than the selective strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin.

Hi

Free clinics may help fill the gap

While the medical system has come under fire recently, thousands of free clinics around the country have been working to fill the holes. Seen as an acute stop-gap for something that is essentially a chronic problem, the cost of these clinics to their providers is generally a tiny fraction of the true value of care received by patients.

No potential medical system can successfully deliver universal coverage while at the same time controlling costs if it does not stimulate the delivery of low cost and free basic services to those most in need.

clipped from www.tcsdaily.com The Free Clinic movement is living embodiment of many conservative principles: the principles of subsidiarity and voluntarism, the spirit of enterprise and of community self-reliance. As health care becomes more and more of a national concern, if people are truly concerned about the less fortunate, there should be a population explosion in the number of free clinics around the country. All the good intentions in the world would not make a free clinic possible in our litigious society. But that problem has been solved in Virginia, whose example could easily be followed. With the help of the Virginia Association of Free Clinics, the state recently established the "VaRISK2" liability risk management program. Operating under the Division of Risk Management of the Department of the Treasury, of the Commonwealth of Virginia, the program indemnifies Directors, Officers, employees, and volunteers in a Free Clinic.

The wrong direction for healthcare?

With the presidential campaigns pushing universal health care back into the forefront of our collective consciousness, the industry itself has gotten into the debate. Unfortunately, it seems to have come in on the wrong side. An article from the New York Post, which appeared on the Cato Institute web page, reports that The American Cancer Society is devoting it's entire advertising budget to the promotion of government-run health care.

Unfortunately for their patients, getting their way will undoubtedly mean worse outcomes. Although free markets often create greater variation in outcomes than bureaucratically managed systems, they are also the only way to guarantee consistent quality care to the majority of customers.

The article, quoted below, elaborates.

clipped from www.cato.org The American Cancer Society announced recently that it will spend its entire advertising budget next year on campaigning for a government takeover of the U.S. health-care system. This is perverse: It's hard to imagine anything worse for cancer patients than government-run health care. Cancer patients understand this. The overall five-year survival rate for all types of cancer for men in America is 66.3 percent, and 62.9 percent for women, the best outcome in the world. free-market U.S. medicine provides the incentives that lead to innovative breakthroughs in new drugs and other medical technologies. U.S. companies have developed half of all the major new medicines introduced worldwide over the last 20 years. Take prostate cancer, for example. we are less likely to die from the disease. Fewer than 20 percent of American men with prostate cancer will die from it, against 57 percent of British men and nearly half of French and German men.

Job's tries to keep his winning streak alive.

Apple's trend of "can do no wrong" will likely get another dose of adrenaline this week, as Jobs makes more pronouncements to wow the faithfull, and catch the attention of some of the rest of us...

clipped from news.bbc.co.uk Chief executive Steve Jobs said Apple "dream big" and wanted to expand the 4.9% market share Safari enjoys. He said Safari was "the fastest browser on Windows", saying it was twice as fast as Internet Explorer. Mr Jobs used the conference to lift the lid on new features of its forthcoming operating system (OS) for Macs, called Leopard. He said the OS has 300 new features and demoed 10, including a new organisational system for the desktop called Stacks and a new folder system which lets users browse files and applications visually, just as music lovers can browse album covers in iTunes. Mr Jobs also gave the greenlight to third-party development of new applications for its forthcoming iPhone mobile phone. Instead of having to test each and every new application themselves, Apple will allow developers to build web applications for the phone which run inside the device's web browser Safari and which were built on existing web standards.

I can't believe Scotland's that bad...

This article reflects the inherent shortcoming of our western society's propensity for quantifying all things. The assertion that Scotland is the worst small western European country rests primarily upon it's shorter life expectancy. This relatively minor, 2 year difference takes in to account none of the things which make a life qualitatively better... like enjoying a fine glass of single malt scotch rather than some snooty French wine...

clipped from news.bbc.co.uk The Federation of Small Businesses' annual Index of Wealth compared 10 countries on economic performance, employment rates, health and education. Scotland's life expectancy rate was a major factor in it coming bottom. The FSB Scotland index examined countries with fewer than nine million people, including Norway, Iceland and the Republic of Ireland. "The reason why Scotland is stuck at the bottom of the pile is largely due to our poor health and our low life expectancy," he said. The figures were 74.2 for men and 79.3 for women, compared to the UK average of 76.6 and 81 years. However, Mr McLaren added that even if health was taken out of the equation Scotland would still be "fairly low" on the table, in about fifth or sixth place.

New 1st line tx. for hepatocellular ca.

clipped from www.medscape.com orafenib (Nexavar) is the first effective systemic treatment for advanced liver cancer. researchers showed that the targeted multikinase inhibitor extends survival by 44%. There is currently no widely accepted standard of care for advanced liver cancer. Doxorubicin is reportedly the most widely used agent, despite the fact that only 1 randomized controlled trial of 60 patients has supported its use and the drug is said to have a 25% rate of fatal complications. Mitoxantrone is licensed for hepatocellular carcinoma but is not considered a gold standard double blind, randomized, placebo-controlled trial, investigators studied 602 patients. The trial, known as the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP), looked at the primary end points of overall survival and time to symptomatic progression. Patients received oral sorafenib 400 mg twice daily or placebo for 6 months, but the trial was stopped early because the findings were so positive