Road to Health ? High Blood Pressure Drug Risk

A new report is out now indicating that a specific class of pharmaceuticals have a high risk of users developing cancer

Cancer link to common heart drugs - http://news.bbc.co.uk/2/hi/health/10295126.stm

You might be healthier if you begin to educate yourself about more natural ways to resolve high blood pressure - from our Road to Health Care Naturally series

Angiotensin receptor blockers (ARBs) are medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate), and blood pressure is reduced.

Examples of ARB drugs include:

• losartan potassium (Cozaar), 2-butyl-4-chloro-1-[p-(o-1H-tetrazol-5­ylphenyl)benzyl]imidazole-5-methanol monopotassium salt. Death is higher in users than placebo for this drug, and it can cause sudden cardiac death. At one point FDA was going to remove it from the market but did not follow though with the action.
• irbesartan (Avapro), 2-butyl-3-[p-(o-1H-tetrazol-5-ylphenyl)benzyl]-1,3-diazaspiro[4.4]non-1-en-4-one. The manufacturer states that there is "No evidence of carcinogenicity was observed when irbesartan was administered at doses of up to 500/1000 mg/kg/day (males/females, respectively) in rats and 1000 mg/kg/day in mice for up to 2 years. For male and female rats, 500 mg/kg/day provided an average systemic exposure to irbesartan (AUC0-24 hour, bound plus unbound) about 3 and 11 times, respectively, the average systemic exposure in humans receiving the maximum recommended dose (MRD) of 300 mg irbesartan/day, whereas 1000 mg/kg/day (administered to females only) provided an average systemic exposure about 21 times that reported for humans at the MRD. For male and female mice, 1000 mg/kg/day provided an exposure to irbesartan about 3 and 5 times, respectively, the human exposure at 300 mg/day."
• valsartan (Diovan), N-(1-oxopentyl)-N-[[2 '-(1H-tetrazol-5-yl) [1,1 '-biphenyl]-4-yl]methyl]-L-valine. In studies completed by the manufacturer they state "There was no evidence of carcinogenicity when valsartan was administered in the diet to mice and rats for up to 2 years at doses up to 160 and 200 mg/kg/day, respectively."
• candesartan (Atacand), (±)-1-Hydroxyethyl 2-ethoxy-1-[p-(o-1H­tetrazol-5-ylphenyl)benzyl]-7-benzimidazolecarboxylate, cyclohexyl carbonate (ester)."There was no evidence of carcinogenicity when candesartan cilexetil was orally administered to mice and rats for up to 104 weeks at doses up to 100 and 1000 mg/kg/day, respectively."
• olmesartan (Benicar), 2,3-dihydroxy-2-butenyl 4-(1-hydroxy-1-methylethyl)-2-propyl-1-[p-(o-1H-tetrazol-5-ylphenyl)benzyl]imidazole-5-carboxylate, cyclic 2,3-carbonate. The manufacturer denies any carcinogenicity in tests up to 2 years of length.
• telmisartan (Micardis),4'-[(1,4'-dimethyl-2'-propyl [2,6'-bi-1H-benzimidazol]-1'-yl)methyl]-[1,1'-biphenyl]-2-carboxylic acid, and, according to the manufacturer, "There was no evidence of carcinogenicity when telmisartan was administered in the diet to mice and rats for up to 2 years." It is important to note that the report found Micardis to be the most at risk drug, and especially for people with diabetes, heart problems, and kidney function issues.
• eprosartan (Teveten), monomethanesulfonate of (E)-2-butyl-1-(p-carboxybenzyl)-α-2-thienylmethylimidazole-5-acrylic acid . "Eprosartan mesylate was not carcinogenic in dietary restricted rats or ad libitum fed mice dosed at 600 mg and 2000 mg eprosartan/kg/day, respectively, for up to 2 years."

Note that most of the drugs contain a benzene ring, known to be linked to carcinogenesis. Benzene has been linked to aplastic anaemia, leukaemia, and other cancers since reports were published in the Lancet in 1961.

Oddly ABC's reporter/MD did not seem to understand why these drugs would be a risk. I say 'oddly' because as an MD he, like I did in my health professional medical education to countless hours of pharmacology.

Keep looking for that benzene ring in any pharmaceutical drug and you know you may have a risk at hand.

Insurance Rates Soar 15 Percent and More

Certainly this report makes a strong case for single payer to cover all citizens in the US, including members of congress.

And please make a point to understand that it is the insurance companies that drive up the costs, as they control all the licensed providers engaged in third party billing.

Individual insurance rates soar in 4 states
By LINDA A. JOHNSON, AP Business Writer
Fri Feb 12, 2010

TRENTON, N.J. – Consumers in at least four states who buy their own health insurance are getting hit with premium increases of 15 percent or more — and people in other states could see the same thing.

Anthem Blue Cross, a subsidiary of WellPoint Inc., has been under fire for a week from regulators and politicians for notifying some of its 800,000 individual policyholders in California that it plans to raise rates by up to 39 percent March 1.

The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent.

Kansas had one recent case where one insurer wanting to raise most individual rates 20 percent to 30 percent was persuaded by state insurance officials to reduce the increases to 10 percent to 20 percent. The insurance department would not identify the company but said it was not Anthem.

And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who purchase individual health insurance, rather than getting it through their employer.

Premiums are far more volatile for individual policies than for those bought by employers and other large groups, which have bargaining clout and a sizable pool of people among which to spread risk. As more people have lost jobs, many who are healthy have decided to go without health insurance or get a bare-bones, high-deductible policy, reducing the amount of premiums insurers receive.

Steep rate hikes in this sliver of the insurance market — about 13 million Americans, as of 2008 — have popped up sporadically for years. Experts see them becoming increasingly common.

"You're going to see rate increases of 20, 25, 30 percent" for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.

Most states don't have the legal authority to block or reduce health insurance rate increases, Praeger noted.

"When you see stories like (Anthem's), you can almost guarantee there's going to be increased consumer protection activity" in state legislatures, she said.

Her group doesn't track rates state by state, but Praeger said it likely will start doing so, "if we don't get any kind of meaningful reform at the federal level."

Politicians and even some health insurers, including Anthem, are urging a revival of the stalled effort in Congress to overhaul the health care system, arguing everyone needs to be covered by health insurance in order to prevent such premium spikes.

In Maine, where Anthem dominates the market, its proposal has several consumer groups planning big rallies at two public hearings on the rates, on Feb. 22 and 24.

Under Anthem's proposal, a family of four could be charged up to $1,876 per month if the proposed rates are allowed to take effect in July.

"The rate request should be denied on its face. It's outrageous," said Greg Howard, spokesman for Maine Change That Works. "We are in the middle of ... this record-breaking type of recession, and they're doing what they need to guarantee profit margin."

On Friday, Maine House Speaker Hannah Pingree and Senate President Elizabeth Mitchell wrote to two congressmen who have scheduled a Feb. 24 hearing on Anthem's pending rate hikes in California, asking them to also look into the proposed hike in Maine.

"We frankly have been very frustrated by the size of these increases," Pingree told The Associated Press. "Obviously, they are attempting to price certain people out of the market."

Last year, Maine's Superintendent of Insurance Mila Kofman rejected Anthem's initial requests, which would have increased individual rates an average of 18.5 percent. She allowed an average increase of 10.9 percent, with the highest increase at 32.4 percent.

Anthem sued the state. Oral arguments in the case are to be scheduled before the Maine Superior Court for mid-March.

Anthem spokesman Chris Dugan said Friday evening the company wants the court to review Kofman's decision because it didn't allow the company an operating profit. He said the rates requested for 2010 are needed "to make sure that we have adequate resources to cover the remaining members" in the insurance plans.

WellPoint, based in Indianapolis, has said it needs to raise rates so much because the weak economy has resulted in fewer people remaining in the individual market in California, and many who do have serious health problems. It says costs of caring for them have been rising due to higher provider prices and more use of diagnostic tests.

In Oregon, state insurance officials have concluded that rising costs justify the higher individual premiums, particularly because most insurers cut rates too much in 2006 and then got hit with significant losses. So double-digit increases, some 25 percent or higher, have been approved, or reduced a bit from 2007 to 2010.

Insurance Division spokeswoman Cheryl Martinis said the agency has started posting details of all proposed increases on its Webspace site and e-mailing customers want a proposal comes in so they can comment.

"People are extraordinarily upset in Oregon, as they are nationwide, about health care costs," she said.

High Cost and Waste: US Health Care System

The concept that health care in the US is costly and wasteful is a decades old evaluation of the system. Over the 40 years I have been involved in mainstream medicine I have heard this argument and discussion more times than you would like to know. Yet little has changed. And I am not too sure the stimulus health plan will much of anything to increase quality, increase access or reduce costs.

It is an odd thing to think that back in the first few years of the 1970s when I started grad school and undertook a program leading me to the nurse practitioner arena, the reason I went in this direction was to increase patient education, improve access to care and focus on prevention.

Now here is the same discussion four decades later: American College of Physicians Issues New Policy on Nurse Practitioners in Primary Care

Why are we having the same discussion? I knew 40 plus years ago what my role was and so did the physicians I worked with (not under). When I was teaching this discipline I knew and so did my students. We were a pretty independent bunch and we practiced in and independent way.

These days it is much more controlled, but the costs aren't the result of tort lawyers.

Drugs are it, labs tests are us, and layer upon layer of bureaucracy at the insurers requires an entire staff of people who do nothing but billing.

Where is that universal claim form we were told we'd see, that would keep costs down?

Oh, yes, I've heard the electronic records story before too. I guess there isn't much I haven't heard.

So why is it that only 80% of health care isn't working after all this time?

Maybe the reason why I switched to natural health care only.

US health system is plagued by high cost and waste: experts
by Jim Mannion

WASHINGTON (AFP) – The United States has one of the world's most advanced but also most complicated health care systems, plagued by widespread waste and costs that have escalated as the US population ages, experts say.

Venturing where others have failed, President Barack Obama is now proposing to spend 634 billion dollars on reforms aimed at expanding health care coverage among the nearly 46 million uninsured Americans.

How he should do it -- and whether it should be done at all -- are likely to be the subject of fierce debate. But, in the words of one economist, the system he inherits is "an administrative monstrosity."

Economist Henry Aaron, in a 2003 paper, called it "a truly bizarre melange of thousands of payers with payment systems that differ for no socially beneficial reason, as well as staggeringly complex public systems with mind-boggling administered prices and other rules expressing distinctions that can only be regarded as weird."

Following are some aspects of the system revealed in a review of the scientific literature by the Rand Corp., a non-partisan think tank, and posted on the website www.randcompare.org.

First, Americans are living longer but two of every three are overweight or obese, one in 10 have diabetes, and about a quarter of the population between the ages of 45 and 54 suffer from hypertension.

More than half are covered by insurance provided by their employers, but it is not required and the quality of coverage varies widely. Nearly 16 percent of Americans have no insurance at all.

Meanwhile, US spending on health care is growing faster than the economy as a whole.

It hit 2.1 trillion dollars in 2006 and was projected to reach 2.25 trillion dollars by 2007, an annual increase of 6.7 percent, according to the Centers for Medicare and Medicaid Services. It could reach 4.3 trillion dollars a year in a decade.

"By 2017, about 20 cents of every dollar spent in the US economy will be spent on health care," Rand said.

The federal government in 2006 covered about a third of US healthcare spending, mainly through its health insurance programs for the poor and elderly -- Medicaid and Medicare.

Payments by private insurances companies accounted for another 34 percent, while out-of-pocket payments by individuals amounted to 14 percent of the total. The remainder came from state and local funds and other private funds.

On average, Americans spend about six percent of their after-tax income on health care, although in the case of the poor or elderly the share is larger.

Among the trends driving up health care spending, the Rand survey found, are lengthening life spans, the spread of obesity, and technological innovations that push back mortality but at a higher cost.

Technological advances alone account for over half the increase in overall US health spending, according to an estimate by the Congressional Budget Office.

"Certain technological changes, for example some vaccines, may reduce spending. However, in general new technologies tend to increase the number of health services that an individual receives, thereby increasing costs," Rand said.

At the same time, the US system is seen as wasteful compared to those of other countries.

The United States spends significantly more on administrative costs than countries with single payer systems -- seven percent compared to 1.9 percent for France, for example, according to the Organization for Economic Cooperation and Development.

And private insurance companies have higher administrative costs (14 percent) than public insurance programs like Medicare or Medicaid, which come in at three to five percent of the total, the literature shows.

"Practitioners and hospitals, in their interactions with multiple payers, are encumbered by numerous billing requirements, a multitude of formulars and clinical care guidelines, and patients with different covered benefits," Rand said.

Studies also have shown that one-third or more procedures performed in the United States were of questionable benefit, according to the think tank.

A 2008 study that compared health care systems in developed countries found that US patients reported waiting less time to get an appointment to see a specialist, but also more problems with the cost of the care and the efficacy of procedures.

Within the United States, however, patients covered by Medicare consistently gave higher marks for the care they received than did those insured by private companies, according to surveys funded by the Agency for Healthcare Research and Quality.

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