Dr Christine Cheng

The makers of Accutane, Hoffman-La Roche Inc, have just lost their first lawsuit for the drug causing Inflammatory Bowel Disorder. Nearly 600 plaintiffs are suing Roche for this condition, and this first win has cost the pharmaceutical giant US$2.6 million!

The plaintiff, Andrew McCarrell is a 36 year old man who took Accutane for cystic acne for a mere 4 months in 1995. He subsequently developed abdominal pain and was diagnosdd with inflammatory bowel disorder. Most of his colon has had to be removed and he lived with a colostomy for years. He has since had a reversal procedure done, but the lack of a colon has resulted in chronic diarrhoea.

The risk of inflammatory bowel disorder has been stated on the drug package insert, but this is not highlighted in the same way as the risk of birth defects is stated. Accutane is also linked to suicidal tendency.

Accutane is a very popular treatment for acne, particularly severe cystic acne. It is the only oral treatment that has disease modifying effects. Dry mouth is very common during treatment.

Other than the risk of birth defects, most doctors are probably unaware of the other high risk consequences of taking this drug. Inflammatory bowel disorder and risk of suicide would be two such problems.

The Roche rep has certainly never mentioned any risks other than dry mouth and avoid during pregnancy when she’s been to see me. Fortunately I’ve yet to prescribe this drug to any of my patients either! I haven’t had to…

Source: International Herald Tribune

Rimonabant (trade name “Acomplia”) is a new slimming pill that suppresses the appetite is said to have metabolic effects over and above weight loss.

The manufacturer Sanofi-Aventis claims that the drug has beneficial effects on the blood glucose and cholesterol levels, thus can modify a patient’s risk of heart disease and diabetes! They claim that this is from the drug altering the metabolism of the fat cells.

There has been some dispute about this. Cynics wonder if the improved blood profile is from the lifestyle changes recommended by the manufacturer. There has also been no direct comparison with the other popular slimming tablets Reductil and Xenical.

Source: Guardian Unlimited

My friend’s son is a genius at multi-tasking. He can watch a video and play on his gameboy at that same time as entertaining his friends. He is a typical 10-year old who needs constant visual stimulation. Part of the new computer-crazy generation. Essentially a couch-potato kid.

A new British study has shown that such lifestyle habits, coupled with junk food and lack of exercise, has reached epidemic proportions in the UK. Over a quarter of the 3500 inner-city secondary children studied were overweight. Only half walked to school. Half of them spent 4 hours a day, or more, watching TV or playing computer games.

In the last decade, the number of obese children has doubled. Since obesity is linked with heart disease and diabetes, this equates to a huge number of children who will not live past the age of 50!

Good lifestyle habits start from childhood. These include eating good food and regular exercise.

Source: Daily Express

Sandwell Hospital at the West Midlands has reported an incident regarding the tampering of some of its portable oxygen cylinders. The general consensus is that a disgruntled member of staff is involved.

The incident was first discovered when doctors attempted to give a sick patient additional oxygen through a face mask. No oxygen was flowing. Fortunately, this was recognised and a new cylinder was brought in, so the patient received the oxygen he needed.

The hospital discovered that the outlet of the cylinder was blocked by a mysterious substance. Two other oxygen cylinders were similarly obstructed too.

This has led to the conclusion of malicious intent.

Why are there so many disgruntled hospital workers worldwide? It seems such a shame that the systems set out to help people treat their own members, the core support workers, so poorly.

I certainly was glad to leave the NHS in 1999. Morale was so very low at that stage. I’m not sure it’s any better now. But things were probably worse in Singapore at SGH. I really hated the inhumane working conditions there.

I love private practice. I have to work very hard at times. I can go for weeks without a single day off, but it’s much more gratifying. And I usually have some semblance of control over my workload.

Source: Daily Mail

The Times reported the conviction of Spanish Consultant Anaesthetist Juan Maeso with 275 counts of causing injuries and 4 counts of manslaughter.

Dr Maeso was a morphine addict who injected himself with morphine that was meant for patient use. The sharing of contaminated needles led to his own infection with the deadly hepatitis C virus. This was diagnosed in the 1990s. He continued to share needles with his patients, leading to 275 infections, 4 of whom died.

Hepatitis C can cause chronic hepatits, cirrhosis and liver cancer.

He was sentenced to 20 years jail for each infected patient, and ordered to pay 500,000 Euros compensation to each patient/family.

To be honest, I’m surprised he would do something so stupid! All doctors know that needle-stick injuries put us at risk of blood-borne diseases such as Hepatitis B, C and HIV. Why would he knowingly put himself at risk?

Most anaesthetists also use cannulae with injection hubs for the administration of drugs. No needles are involved at the point of patient injection. We rarely use direct injection into the vein for the sheer number of drugs involved and the number of injections that have to be done through an operation. It’s all rather strange.

But yes, Anaesthetists do seem to be a high risk group for drug abuse.

I have had a colleague who was addicted to fentanyl. We weren’t any the wiser until he decided to play with remifentanil one day. He forgot his pharmacology. Remifentanil acts very fast and causes dramatic respiratory depression, so he basically stopped breathing and collapsed.

He was found by an Eye Surgeon who saw his leg stuck out of the toilet cubicle door.

We later discovered that he was behind all the missing vials of fentanyl in theatre, and he wore long sleeves all the time to cover the needle puncture marks (not because he was cold like the rest of us!).

Experts have recently linked obesity with cancer, stating that up to a staggering 40% of cancers can be prevented by simple lifestyle changes!

With obesity affecting increasing numbers of the population worldwide, plus the general ageing of the developed world, the incidence of cancers caused by obesity is set to sky-rocket!

And we thought diabetes melliltus and heart disease being linked to obesity was bad enough.

Moral of the story: eat less, exercise more. Stay trim, stay fit.

Source: Daily Mail

Someone who appears to be thin may have a large amount of fat internally (TOFI). The fat infiltrates the liver, underused muscles and wraprs around organs like the pancreas.

TOFIs are at high risk of insulin resistance, to the same degree as someone who is obese. That puts such slim individuals of diseases associated with obesity such as diabetese melliluts and heart disease.  What a shocker!

So what causes TOFI?

Internal fat is measured by MRI scanning. The fat is seen as yellow in the image, which is of a 28-year old sedentary male who eats healthily.

TOFI is associated with lack of activity. Controlled food intake will results in low subcutaneous (skin) fat thickness. However, only exercise will eliminate internal fat.

It is not important to just look thin. Regular exercise is essential for optimal health.

Source: Associated Content

Daily high dose Aspirin of 300mg can dramatically reduce the risk of developing bowel cancer.

Bowel cancer is a big cause of morbidity in Singapore. The ability to reduce the risk of developing this disease with a simple Aspirin tablet could dramatically change a Nation’s health.

Daily treatment is needed for at least 5 years before the benefits are seen. The patients were treated in the 70s and 80s and followed up for the last 20 years. The treatment group saw a reduction in deaths from bowel cancer by 74%!

The risk reduction did not depend on age, sex, race or country of origin.

We recently saw that high doses of Aspirin can increase the risk of haemorrhagic stroke in the elderly. Aspirin can also increase the risk of gastro-intestinal bleeding.

We also know that low-dose Aspirin is cardio-protective. Further studies need to be done to see if Aspirin 75mg per day can protect against bowel cancer too.

In the meantime, daily Aspirin at 300mg should be considered for individuals at high risk of bowel cancer.

The Daily Mail reports that Superfoods which are increasingly popular recently may not have benefits fitting their price tags.

Berries

Claim: Packed with nutrients, berries are needed for brain development and boosting of  IQ, energy and immunity.

Truth: No evidence to back theory. Berries are rich in folate which boots brain power, but this is found in many food types.

Pomegranate Juice

Claim: Full of anti-oxidants to ward off cancer, heart disease and arthritis

Truth: Blood anti-oxidant levels are raised for only an hour after consumption of pomegranate juice

Wheatgrass

Claim: Contains chlorophyll which purifies the blood and detoxifies the body

Truth: Chlorophyll levels are no higher than other green vegetables. Plus chlorophyll is not absorbed into the body.

Seaweed

Claim: Enhances immunity, boosts brain power, prevents obesity, depression and anaemia

Truth: Seaweed contains the same nutrients as all other vegetables.

Ultimately, eating a varied wholesome diet with minimal processing and a large number of colours (and I don’t mean ketchup!) will provide the widest nutrient balance for optimal health.

The Telegraph has reported the UK Plastic Surgeons’ concerns regarding the lack of regulation with Medical Spas.

These establishments appear to provide invasive treatments such as Botox and Fillers without any medical supervision! The Medical Spas seem to feel this is safe as long as they keep to a strict sense of hygiene.

I’m not sure I would agree with that. Anything that involves injections should only be done under medical supervision. Certainly the treatments done are safe. But only under the right hands. And hygiene standards alone do not guarantee the ability to deal with any problems that ensue. And complications do occasionally happen.

For example: granuloma formation with hyaluronic acid fillers. Would Aestheticians know how to recognise and treat such an occurrence? Ptosis with Botox: they can’t prescribe the required eye drops to enhance muscle activity.

Where will they stop? Syringe liposuction? Thread lifts?

Aesthetic procedures have been de-regulated in the UK recently. I was wondering what the controversy was about. Surely doctors, particular the ones trained in the UK, know their limits and would not overstep the boundary. Now I see the point of contention.

Once again, I back the Plastic Surgeons and say that procedures, even minimally invasive ones, should be performed by a medically qualified person only.