So I made it to Thailand in one piece. After a 31hour flight in which I literally slept for five minutes I felt as though I might have eaten a handful of mushrooms not that I know what thatrsquos like once I departed the airport and made my way into Chiang Mai. I mean isnrsquot Nyquil supposed to knock you out on a long flight Arenrsquot 8 glasses of red wine supposed to knock you out
Monthly Archives: January 2010
Winter Deals on Vacation Rentals
ABetterStay has leading vacation rental and condos in popular vacation Destinations around the world. With impressive properties from coast to coast yoursquoll be sure to find something that meets your needs. Check out these areas as many properties are running great beginning of the year specials. Aspen Vacation Rentals Bahamas Vacation Rentals Big Sky Vacation Rentals Vacation Rentals
UGG Classic Mini Boots of Valentines Special
The UGG Classic Mini Boots with various color and styles created by UGG Australia.Classic Mini UGG Boots are made from Genuine Grade A twinfaced sheepskin with suede heel guard. Classic Mini UGG Boots are doublestitched in parts which assures the highest quality. These sheepskin boots are incredibly comfortable as the sheepskin is providing excellent insulation against the coldbut also absorb
Mashup Fashion
Do you think there's a difference between design and craze Or are they interchangeableI find myself mulling over this one pretty a bit. While the two are in no means mutually total I do think that they are very different. When superstar asks if I respect BCC a technique blog or a method blog I immediately answer comfort blog. And even although I'm so certain that I am one and not the ot
Sydney and Melbourne
hey there. sorry it has taken so long to uptate have been traveli garound and didnt get any chance of going on the internet to write.Now im in Melbourne got here yesterday after a 8 hour long drive down from Sydney. spendt about 4 days in Sydney wich was great. saw the Opera house the nice brigde and spent alot of time in the nice park they got where we saw Prins william from england. really
Glacier country one I climbed and then fell out of a plane above.
Shock and horror. You can't get Fox's Glacier Mints at Fox's Glacier o In other news it was shut despite the fact it has been there for millions of years carving away at the landscape a flurogit with a walkie talkie and a rope prevented all progress near to the actual Glacier. The good news is I have a helihike booked to make up for it on a much larger Glacier Franz Josef. To che
Two NBA Players
So make solid to try out the shoe and evaluate with great support and bestow continuous carry to every part of the base to make the operation experience a level one. A good operation shoed provides comfort and pillar from rolling his or bad help of the arch can fashion great discomfort and injure over the platform of the shoe. The helps to stop a sprinter from beginning to end. At the same can be
Oh Chiang Mai…
Well Chiang Mai was bittersweet. The first actual day I had I meet up with Nana who is a friend from Vernon's penpal you could say. She met me at my guesthouse. She was like half my size but very cute and polite. She liked to giggle a lot. We took a taxi to the biggest temple about an hour away from the town and had met a local canadian from Vancouver. He was a bit too friendly about 40 year old
Hong Kong to Macau
Just a short update on the past week from travelling from Hong Kong to Macau. We left Hong Kong on Wednesday morning or so we planned to leave then but Andrew had a few places he had to visit to purchase more protein powder before we left Hong Kong. We finally left just after lunch time to catch the train from Causeway Bay to Sheng Wai to board the ferry for Macau. We booked the hotel The Best
5 nights in bangkok
We seem to have found our favorite activity in bangkok. Sitting at the Wild Orchid on soi chanasongkram sipping drinks and watching people go by. The music they play ranges from sappy ballads and muzak versions of villiage people songs all the way to breakestra.The city is very intense but you just need to be firm with all the touts and keep walking. If you stop you will be accosted and hav
Boquete…
We woke up early and took a taxi to the bus terminal at 830am we then got the 945am bus to David. The journey to David took around 8 hours but we pretty much dozed for the entire ride We arrived in David around 6pm and straight away jumped onto the next bus to Boquete. The bus to Boquete was a very cramped Red Devil the journey lasted around 1 hour. Once in Boquete we took a taxi to our hotel
Great Ocean Road Trip Part 1
Leaving the drizzly Blue Mountains we headed towards Sydney for our short flight to Melbourne and the start of our road trip along the Great Ocean Road. We had booked with Qantas and the queue for luggage check in turned out to be reminiscent of the queue for New Yearrsquos Eve minus the spectacular fireworks. Qantas like Virgin probably have a bit of work to do if they are going to thrive
Chi Hair Straightener hair straig
Now let us see why the hair experts recommend ceramic hair straighteners. The question may always arise what is there in a ceramic hair straightener which is not present in ordinary hair straighteners. The fact is that the ceramic heating technology emits negative ions. These negative ions helps in closing the cuticle layers of the hair and while doing so the natural moisture which is very esse
The Motorcycles Trip
Hue City tour by Motorcycles
contacts
Hey just a quick note to post my conact deets.My cell is 6657 1321 and I should have this for the next 7 months. To call me from Canada or the States I believe you dial 011 507 6657 1321. That being said I rarely actually have my cell it's more for emergencies and meeting my internship directors in towns etc. But if you want to set up a time to call I can make sure I have it on.Next my mai
Airport Chronicles
When I signed up for this trip across the Earth and looked at the flight over I thought to myself ldquoEhhellip 31 hours no big deal.rdquo After all Irsquove flown back and forth to Thailand before how bad could it be How long could it really feel like Surely it couldnrsquot be unbearable for me a weathered traveler to handle. However sitting now in a jumbo jet flying overhell
Where Am I Going
Day 56 January 2122 2010Irsquove been busy the last couple of days trying to figure out where Irsquom goingstaying so many hours have been spent in front of a computer instead of enjoying Sydney Day 5 began with getting some necessities taken care of. I had to get cash which I hadnrsquot done since Irsquove been here and I had to buy a new phone because the SIM card I got didnrsq
Indonesia Java International Destination
lta hrefhttpwww.blogkatro.com200912indonesiajavainternational.html targetblankgtltbgtIndonesia Java International DestinationltbgtltagtIt is fully recommended that it is worth to place Indonesia Java International Destination same as Bali travel and Bali vacation tourisme guidance list and your online reference. Travel in indonesia is always excited. When it plans
Day 2 cont.
Sorry about that friends I thought I had saved the most recent additions but I guess not. So now I have to go back and upload the photos again.....as I was saying....The climbs are exhausting but the views are worth it. I feel another long nights sleep coming on after dinner. Ya Mon BequiaDavid
Don’t Believe The Hype: Cholinesterase Inhibitors As A Treatment For Dementia
Don’t Believe The Hype: Cholinesterase Inhibitors As A Treatment For Dementia
I distinctly remember the day I attended a “drug lunch” (as a PM&R resident in New York City) to learn about the value of donepezil (aricept) for the treatment of dementia. I was astonished by the drug’s lack of efficacy – the graph displayed in the PowerPoint show demonstrated a 2-point improvement on the Mini Mental State Exam (MMSE), an effect that began after 6 months of donepezil use, and persisted for only 6 months after that. A 2-point difference on the MMSE has no clinical relevance of which I’m aware. The drug’s common side effects include: nausea, vomiting, diarrhea, loss of appetite, tiredness, drowsiness, trouble sleeping, or muscle cramps. That day I vowed never to prescribe the drug to my elderly patients.
Nonetheless, I was dumbfounded by the number of patients who came to the hospital already on the medication. Over and over again I heard the same story: “mom is becoming forgetful so our doctor started her on this medication to help her memory.”
When I asked if the family if they thought the medicine helped, the response was equally predictable: a shrug and then “what else can we do?”
Here we have a classic example of a medical problem with no satisfactory treatment or cure – and a desperate desire on the part of patients and family members to do something – anything – about it. Many times people in these predicaments turn to alternative medicines, herbal supplements and faith –based remedies. And sometimes they turn to FDA-approved drugs.
The Cochrane Collaborative has reviewed the scientific literature on the use of cholinesterase inhibitors (like donepezil) in mild dementia, and has found:
There is no evidence to support the use of donepezil for patients with mild cognitive impairment (MCI). The putative benefits are minor, short lived and associated with significant side effects. http://www.cochrane.org/reviews/en/ab006104.html
So how did this drug get approved? Well, there do seem to be some small improvements (of dubious clinical significance in my opinion) in measures of cognitive impairment in patients with Alzheimer’s dementia in particular. http://www.cochrane.org/reviews/en/ab005593.html
AHRQ states:
The evidence is mixed, however, about the effects of cholinesterase inhibitors on functional measures such as instrumental activities of daily living (i.e., ability to use the telephone, mode of transportation, responsibility for medication, and ability to handle finances). In general, the studies show little or no effect on functional decline after 6 months of treatment and a small but statistically significant difference from placebo after 12 months of treatment.
Research has found no clinically important differences between people taking cholinesterase inhibitors and those taking placebo in the development of behavioral and psychological symptoms… Studies rarely addressed other important health outcomes such as utilization of health care services, injuries, and caregiver burden.
Pfizer’s press release (when they received FDA approval to market Aricept in 1996) noted:
Alzheimer’s disease is a family tragedy. ARICEPT will benefit patients and families alike by improving or maintaining patient function, which in turn may help ease the burden for caregivers and help maintain personal dignity… “ARICEPT represents a significant step forward in addressing the therapeutic needs of the Alzheimer’s disease community…This therapy will help to change the approach to the management of Alzheimer’s disease.
Global sales of Aricept were approximately $1.1 billion for 2008 alone.
Me-too cholinesterase inhibitors have seen similar global profits, with sales of namenda at about $1 billion as well in 2008. http://www.businessweek.com/magazine/content/04_14/b3877629_mz073.htm All this while the AHRQ can find no clinically relevant difference between the drugs in this class, and the effects they have are small and short lived.
There are pharmaceutical innovations that have changed the course of history (imagine where we’d be without the polio or smallpox vaccines), while others leverage the tiniest statistically-significant effects to drive global drug empires driven by public feelings of helplessness in the face of currently incurable diseases.
It’s no wonder that the public has a mistrust of pharma – their marketing engines drive sales of drugs that have vastly different clinical value. That means it’s up to physicians and scientists to tease out the legitimate enthusiasm from the marketing hype. And judging from all the patients with mild dementia that I see on cholinesterase inhibitors, I give us a failing grade.
I distinctly remember the day I attended a “drug lunch” (as a PM&R resident in New York City) to learn about the value of donepezil (Aricept) for the treatment of dementia. I was surprised by the drug’s lack of efficacy – the graph displayed in the PowerPoint show demonstrated a 2-point improvement on the Mini Mental State Exam (MMSE), an effect that began after 6 months of donepezil use, and persisted for only 6 months after that. A 2-point difference on the MMSE has no clinical relevance of which I’m aware. The drug’s common side effects include: nausea, vomiting, diarrhea, loss of appetite, tiredness, drowsiness, trouble sleeping, or muscle cramps. That day I realized that the risk-benefit profile did not support its use.
Nonetheless, I was perplexed by the number of patients who came to the hospital already on the medication. Over and over again I heard the same story: “Mom is becoming forgetful so our doctor started her on this medication to help her memory.”
When I asked the family if they thought the medicine helped, the response was equally predictable: a shrug and then “What else can we do?”
Here we have a classic example of a medical problem with no satisfactory treatment or cure – and a desperate desire on the part of patients and family members to do something – anything – about it. Many times people in these predicaments turn to alternative medicines, herbal supplements and faith –based remedies. And sometimes they turn to FDA-approved drugs.
The Cochrane Collaboration has reviewed the scientific literature on the use of donepezil in mild dementia, and has found:
There is no evidence to support the use of donepezil for patients with mild cognitive impairment (MCI). The putative benefits are minor, short lived and associated with significant side effects.
So how did this drug get approved? Well, there do seem to be some small improvements (of dubious clinical significance in my opinion) in measures of cognitive impairment in patients with Alzheimer’s dementia in particular.
The Agency for Healthcare Research and Quality (AHRQ) states:
The evidence is mixed, however, about the effects of cholinesterase inhibitors on functional measures such as instrumental activities of daily living (i.e., ability to use the telephone, mode of transportation, responsibility for medication, and ability to handle finances). In general, the studies show little or no effect on functional decline after 6 months of treatment and a small but statistically significant difference from placebo after 12 months of treatment.
Research has found no clinically important differences between people taking cholinesterase inhibitors and those taking placebo in the development of behavioral and psychological symptoms… Studies rarely addressed other important health outcomes such as utilization of health care services, injuries, and caregiver burden.
Pfizer’s press release (when they received FDA approval to market Aricept in 1996) noted:
Alzheimer’s disease is a family tragedy. Aricept will benefit patients and families alike by improving or maintaining patient function, which in turn may help ease the burden for caregivers and help maintain personal dignity… Aricept represents a significant step forward in addressing the therapeutic needs of the Alzheimer’s disease community…This therapy will help to change the approach to the management of Alzheimer’s disease.
Global sales of Aricept were approximately $1.1 billion for 2008 alone.
Me-too cholinesterase inhibitors have seen similar global profits, with sales of rivastigmine at close to $1 billion in 2008. All this while the AHRQ can find no clinically relevant difference between the drugs in this class, and the effects they have are small and short lived.
There are pharmaceutical innovations that have changed the course of history (imagine where we’d be without the polio or smallpox vaccines), while others leverage the tiniest statistically-significant effects to drive global drug empires driven by public feelings of helplessness in the face of currently incurable diseases.
It’s no wonder that the public has a mistrust of Pharma – their marketing engines drive sales of drugs that have vastly different clinical value. That means it’s up to physicians and scientists to tease out the legitimate enthusiasm from the marketing hype. And judging from all the patients with mild dementia that I see on cholinesterase inhibitors, I think most of us deserve a failing grade.
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