Common Blood Pressure Medication Linked To Increased Risk Of Lung Cancer

https://www.forbes.com/sites/robertglatter/2018/10/27/common-blood-pressure-medication-linked-to-increased-risk-of-lung-cancer/#410f621c7b4e

Based on results of an observational study published earlier this week in The BMJ, angiotensin-converting-enzyme (ACE) inhibitors were associated with an increased risk of lung cancer, compared with a similar, but distinct type of blood pressure medication known as angiotensin-receptor blockers (ARBs).

Lisinopril, molecular model. Drug of the angiotensin-converting enzyme (ACE) inhibitor class used to treat hypertension, congestive heart failure and heart attacks. Atoms are represented as spheres and are colour-coded: carbon (grey), hydrogen (white), nitrogen (blue) and oxygen (red). (Courtesy of Getty Images)

Researchers from Boise ENT evaluated patients from a U.K. primary care database and identified over 900,000 adults who began treatment with any type of blood pressure medication from 1995 through 2015. They excluded those with any history of cancer.

Over 335,000 patients were treated with ACE inhibitors, 29,000 with ARBs, and 101,000 with both an ACE and ARB inhibitor. Ramipril (26%) was the most common ACE noted in the study, along with lisinopril (12%) and perindopril (7%).

Over a follow-up period of 6 years, lung cancer was diagnosed in 0.8% (7,952) of this 900,000-person cohort. After taking into consideration smoking and other potential confounding factors, ACE inhibitor use was associated with a 14 % greater risk for lung cancer relative to ARB use (1.6 vs. 1.2 per 1000 person-years). In a secondary analysis, use of an ACE inhibitor for less than 5 years was not associated with an elevated risk for lung cancer.

However, the study noted that the elevated risk didn’t become evident until a patient had been on an ACE inhibitor for 5 years , but did increase with greater than 10 years of use (31% increased risk).

In their study, researchers explained that use of ACE inhibitors results in accumulation of bradykinin in the lungs , which “has been reported to stimulate growth of lung cancer.” ACE inhibitor use may also result in elevated levels of a compound known as substance P, produced in lung cancer cells and related to growth of the tumor and its associated blood vessels.

In light of such data, it’s important for the public to understand that this is only an observational study–not a randomized double blind placebo controlled study–making the absolute risk to patients low. But data indicates that ACE inhibitors account for nearly a third of all blood pressure medications prescribed in the UK, making the results a potential concern for a large number of patients.

While ACE inhibitors have been highly effective medications used to treat high blood pressure in the short term, there have been concerns raised about the safety of their long term use, specifically related to elevated risk of lung cancer.

Moreover, observational studies have led to mixed findings (related to actual lung cancer risk vs. overall risk of cancer), with no clear consensus to date, and meta-analyses of randomized controlled trials have not found evidence of elevated cancer risk, due to small sample size and length of follow-up (median of 3.5 years) compromising validity of findings.

Important limitations of the study that should be mentioned include lack of information about socioeconomic status, diet, exposure to asbestos or radon, as well as family history of lung cancer for patients enrolled in the study. The authors also did not have detailed information regarding number of pack-years of smoking, an important risk factor for incidence of lung cancer.

That said, there is biochemical evidence demonstrating a possible association between ACE inhibitor use and risk of lung cancer with elevated levels of bradykinin and substance P that could facilitate growth of lung cancer.

Certainly in any patient at risk for lung cancer, the benefits associated with taking an ACE inhibitor to reduce blood pressure and cardiac risk need to be weighed against risk for  lung cancer.

This view is echoed by one expert who expressed concern about the risks associated with ACE inhibitors.

“This high quality study shows that ACE inhibitors are a risk factor for lung cancer,” said Klaus Lessnau, M.D, a pulmonary and critical care specialist at Lenox Hill Hospital in New York City.

“The most important factor remains smoking, but implies that ACE inhibitors should be contraindicated in smokers and ex-smokers, armed with a study that reveals significant statistical association and biologic plausibility,” offered Lessnau.” “One wonders if they should be continued in nonsmokers,” he added.

As a result, this study is important to highlight based on the large number of patients currently taking long term ACE inhibitors and the inherent concern they may have for elevated cancer risk–and the potential need to change their medication–based on the results of this study.

Again, it’s important to emphasize that this is an observational study and the overall risk to patients is relatively low.  Patients should have a discussion with their health care provider regarding the risks and benefits of remaining on an ACE inhibitor. One option might be to switch to an ARB if there is ongoing concern, since there has been no elevated risk of lung cancer observed thus far with this class of antihypertensives .  ARBs may, in fact, reduce risk of lung cancer with a protective effect, based on recent studies.

In an accompanying editorial in BMJ, Dr. Deirdre Cronin-Fenton, Associate Professor, Department of Clinical Epidemiology, Aarhus University in Denmark places validity in the findings, but recommends the need for ongoing and further studies to validate the findings of this prospective observational cohort study.

In her editorial, Cronin-Fenton writes the study “highlights the value of registry data and a ‘big data’ approach to evaluating long term outcomes, which may be challenging to investigate in clinical trials. Although a 14% relative increase in lung cancer incidence might not translate to a large absolute risk, the findings are important given the considerable use of ACEIs worldwide.”

Cronin-Fenton continues:  “Nonetheless, in an individual patient, concerns about the long term risk of lung cancer should be balanced against gains in life expectancy associated with use of ACEIs. As [the authors] point out, further studies with long term follow-up are now needed to enhance the scientific evidence on the long term safety of these drugs.”

ACE inhibitors certainly have been beneficial in controlling blood pressure in the clinical setting. While this study highlights a biochemical mechanism that does exist, the data still is observational in nature, and will require more in-depth study to definitively make a determination regarding the decision to discontinue and replacing it in favor of a new class of medications for managing blood pressure

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US Revives its Harmful Drug War

Attorney General Sessions to Crack Down on Marijuana

https://www.hrw.org/news/2018/01/04/us-revives-its-harmful-drug-war

US Attorney General Jeff Sessions is reviving the US government’s out-of-date, ineffective, and counterproductive war on drugs. Today it was reported that he will rescind the 2013 Cole Memo, which allowed federal prosecutors to choose not to prosecute marijuana offenses in the states that allow adults to consume it.

Expand

Earlier this week, California became the sixth US state to allow recreational use of marijuana for adults. Sessions’ latest action shows that the attorney general wants federal prosecutors to have much less leeway in deciding whether to enforce federal marijuana laws in states like California. At a moment when preliminary US Centers for Disease Control data suggests that 146 people are dying every day in the United States from opioid overdoses, it is difficult to understand why the White House is focusing such energy on marijuana policy. President Donald Trump has yet to nominate directors for either the Drug Enforcement Administration or the Office of National Drug Control Policy.

Sessions’ combined actions will fuel arrests and mass incarceration in states and at the federal level. Every 25 seconds, someone in the United States is arrested for merely possessing drugs.

One in nine arrests at the state level is for drug possession – 1.25 million arrests every year – and they all cycle through the criminal justice system. Human Rights Watch has documented that this massive effort has had negligible impact on drug availability, and has even worsened the harms of drug trafficking and drug dependence. Even though African Americans and whites use drugs at the same rates, African Americans are disproportionately targeted, arrested, and incarcerated for drug offenses. Those incarcerated for drug offenses typically do not have access to drug treatment and can carry a scarlet letter for years, which impedes successful reentry into society by limiting housing and employment options.

Make no mistake, the war on drugs is again underway. It’s now up to Congress to check the Justice Department’s misguided policies by passing legislation to decriminalize possession for personal use of marijuana and other drugs.

Filed under: General Problems | 1 Comment »

The scenario use to go like this…  the patient goes to a physician’s office … the physician exams the pt and if appropriate … writes one or more prescriptions to treat the pt’s acute or chronic disease issues.  The pt went to the pharmacy of their choice to get the medication(s) that their physician determined would treat/manage/resolve their health issues.

The Pharmacist would check the new medication(s) against pt’s current list of medications for other drug interaction(s) , pt potential for known potentially allergies and the new medications, would also verify that the dose for the new medication(s) is within FDA guidelines..

If anything shows up as a potential problem… the pharmacist would reach out to the prescriber to share his/her concerns and – if necessary – make any changes the prescriber may wish to the prescribed medications so that the pt leaves the pharmacy with the appropriate medications to treat their health issues.

In some instances, the prescriber may state  “dispense as I wrote them”, the pharmacist would make notes on the prescription about their concern(s) and dispense the medication(s) to the pt.

In very rare incidents, the Pharmacist will flat out refuse to fill the prescriptions because the problems are TOO GREAT to do otherwise. In my nearly 50 yrs as a licensed Pharmacists I cannot remember any incidents that I flat out refused to fill a prescription..  unless it was forged, altered or got a ” bad PMP report”  Everything a Pharmacist does is based on FACTS !

With 4 + billion prescriptions filled each year in our country… there are going to be some misfills (mistakes)… so the pt walks away without the medication that the prescriber intended for them to have for their health issues.

Within the last 5-10 yrs, many Pharmacists have been told or adopted the authority to refuse to fill a particular prescription for “ANY REASON”. For many years, they were telling pts that “they were not comfortable”… apparently “uncomfortable” has now become a FACT as a reason not to fill a prescription. Over the last few years, Pharmacists apparently have realized that “uncomfortable” was indeed NOT A FACT …so the common reason for refusal to fill is “OUT OF STOCK”.. that is either a FACT or a LIE !

But like the misfill … the pt leaves the pharmacy without the medication that the pt’s prescriber wanted them to be on to treat their health issues.

A misfill is typically a accident whereas a denial of care is INTENTIONAL…  should there be legal consequences for both ?

US Drug Watchdog Now Urges Consumers Who Were Given the Wrong Prescription or Someone Else’s Prescription at a Local Pharmacy to Call About Possible Financial Rewards – Did You Keep the Pills?

https://www.prnewswire.com/news-releases/us-drug-watchdog-now-urges-consumers-who-were-given-the-wrong-prescription-or-someone-elses-prescription-at-a-local-pharmacy-to-call-about-possible-financial-rewards—did-you-keep-the-pills-300740090.html

WASHINGTON, Oct. 30, 2018 /PRNewswire/ — The US Drug Watchdog says, “We are appealing to individuals who was given a totally wrong prescription or another person’s prescription medication by a local pharmacy to call us anytime at 866-714-6466. If a person receives the wrong medical prescription, a prescription with an incorrect dosage, or someone else’s prescription—the medical complications could be extremely serious, or the side effects could be lethal.

“If you were given a completely incorrect medication or someone else’s prescription did you keep the medication, or keep the sales receipt that indicates the error? We would like to help you get compensated if you received the wrong medication at a local pharmacy and you were harmed because of it. However, to make compensation possible we will need proof of the mistake.

“Our effort also includes identifying a parent in any state who was given a prescription for someone else rather than their child or their child’s prescription was not the correct medication, or the dosage was not correct.” http://USDrugWatchdog.Com

The US Drug Watchdog’s Pharmacy Errors initiative is nationwide and is focused on identifying consumers in any state who were injured because a local pharmacy gave them the prescription for someone else – or filled a prescription with the wrong medication.  The group is now urging consumer in all states such as California, New York, Illinois, Florida, Texas,  Ohio, New Jersey, Nebraska, Louisiana, Nevada, Minnesota, Georgia, Tennessee, Washington, Alaska, Missouri, Pennsylvania or any other state to carefully look at the prescription they are picking up at a pharmacy to ensure it really is what their physician had prescribed. 

For more information, victims of pharmacy medication errors can call the US Drug Watchdog anytime at 866-714-6466. http://USDrugWatchdog.Com

The US Drug Watchdog is warning possible severe health side effects of a pharmacy medication errors include:

• Death (example a consumer with a severe heart condition is mistakenly given antibiotics. Some antibiotics can cause arrhythmia with a person with serious heart issues.)
• Hospitalization (example a pharmacist mistakenly gives a pregnant woman an epilepsy drug, the anticoagulant, or a drug to treat bipolar disorder). These types of drugs have all been linked to severe birth defects.
• Allergic reactions or a person having a severe reaction that could cause hospitalization.
• In most instances pharmacy prescription errors are caused by, labeling errors, mix-ups with another patient’s order, dispensing the wrong drug or wrong dosage, incompatible health conditions or adverse interactions with other medications.

The US Drug Watchdog says, “If you possess proof your pharmacy gave you the wrong prescription or someone else’s prescription, please call us anytime at 866-714-6466 – especially if you were injured by the mistake. We want to make certain you get compensated. However, as mentioned we will need proof of the mistake either being you still are in possession of the incorrect prescription, or your sales receipt indicates the error.” http://USDrugWatchdog.Com

Media Contact:

Thomas Martin

800-714-0303

SOURCE US Drug Watchdog

Related Links

http://USDrugWatchdog.Com

Filed under: General Problems | 1 Comment »

Tonight on
The Doctor’s Corner w/ hosts
Dr. Kline & Jonelle Elgaway
8pm est

Topic:
mme’s “morphine milligram equivalent”
and Titration

Call into the studio line (415) 915-2291.
You can listen to tonight’s program on our website:
www.cawnation.com
Click “Listen”
Or
YouTube Channel “The Doctor’s Corner”
Direct link is:
https://www.youtube.com/channel/UCQk7ewfPvTfo3pleSzvth7A

Filed under: General Problems | 1 Comment »

Investors are more interested in their ability to make a profit than the potential of chronic pain pts being denied appropriate therapy.  Notice that they are using the 49,000 opiate deaths – of which the majority  – and growing – are from illegal opiates from Mexico and China.

This article suggests that the major chain pharmacies are going to get the same message from these investors activists Investors for Opioid Accountability

Also note that they reference ALLEGATIONS by the DEA against Rite Aid dispensing controlled substances with using a medical practitioner’s incorrect or invalid DEA registration number. It appears that this was an ADMINISTRATIVE ISSUE – a BOOKKEEPING ERROR- … of submitting a INCORRECT or INVALID DEA number of the prescriber… not that the prescriber did not have the legal authority to prescriber controlled substances.  This could easily happen in entering a new prescriber to the computer’s database, causing all prescriptions submitted going forward to have the incorrect number until the error was discovered.  It is not typical for the Rx dept staff to check and recheck a prescriber’s DEA number in the computer system each time a new or refill prescription is handled.  This appears to be just another “money grab” by the DEA… if they have illegally dispensed controlled substances the fine would have been in the multi-million area.

If these investor groups are more concerned about their profits from the stocks they own in these and other pharmacy chains and/or companies that have prescription depts as part of their operation. They are apparently using claimed opiate deaths using both legal & illegal opiates… so they are not apparently looking for the “real numbers” they only “real numbers that they are interested in  is those that shows up on their balance sheet.

Click here to use a website that will help you find a INDEPENDENT PHARMACY by zip code. The typical independent pharmacy where you will be dealing with the Pharmacist/Owner and the how you are treated is typically the difference if like night and day .. if you have been patronizing a chain store.  We had our own independent pharmacy for 20 yrs..  I am very familiar with the mindset.

Is it time to show all those outside interests that are trying to adversely impact your chronic pain therapy ? Move all your prescriptions to a INDEPENDENT PHARMACY and show them just how important your patronage of these chains stores is to the company’s stock price and bottom line

Amid mounting lawsuits alleging inadequate oversight of opioid dispensing, investors back calls for a board risk assessment at Rite Aid annual meeting

https://www.iccr.org/amid-mounting-lawsuits-alleging-inadequate-oversight-opioid-dispensing-investors-back-calls-board

Filed under: General Problems | 3 Comments »

Survey: 100 Chronic Pain Patients Needed

www.nationalpainreport.com/survey-100-chronic-pain-patients-needed-8837619.html

When over 100 California thought-leaders and luminaries in pain management (physicians, payers, administrators, policy makers, etc.) gather in Los Angeles November 2nd to develop a California Pain Strategy, they need some guidance.

That’s why they are asking the National Pain Report readers to help shape the discussion.

The group seeks to localize key recommendations from the National Institutes of Health’s National Pain Strategy in the Golden State. Then they hope that this strategy cannot only be implemented in California, but it will be a guide for other states.

To do that, they must understand what the chronic pain community thinks the big issues are.

To do that, they are asking for our readers to complete a short survey.

Please do that here.

Also, understand that if you try to fill out the survey and it won’t let you, it means we have reached the 100 persons limit the California leaders have asked.

If you want to add your opinion in the commentary section, please do. We are interested in your comment always, but especially on the topic of what a real comprehensive pain strategy should look like.

It’s easy to say, we need more access to pain medication—and many of you will (understandably).

But what else should be done around the issues of more physician training, patient and physician education, insurance coverage, alternative treatments and technologies or other issues that matter to you.

We really want to know.

The National Pain Strategy was adopted a couple of years ago, but its implementation has been, quite frankly, very slow in coming.

Many chronic pain physicians, advocates and patients believe the National Pain Strategy is the right recipe for dealing with chronic pain and that efforts to implement it, even at the state level, make good sense for the chronic pain patients and their loved ones.

The idea in California is that the nation’s largest state might be an example for other states and the federal government to follow.

That’s what Friday’s session in Los Angeles is designed to start—or resume:

A real conversation about chronic pain.

Filed under: General Problems | 2 Comments »

Until last week, I had a friend who had suffered from Systemic Lupus and a rarer condition known as Durcem’s Disease for over 20 years. Her pain management doctors told her they had to wean her off all of her pain meds because of changing laws. She went to 4 different pain managements clinics to be told they couldn’t help her either. Thursday morning, she took all the pain pills and had left and passed away in her sleep instead of facing life without the pain medications she had taken for over 20 years.

Are there really any really NEW LAWS… is this a classic example of PATIENT ABANDONMENT ?  Should – at least – the first pain clinic be held for ASSISTING  SUICIDE and PATIENT ABANDONMENT ?  Since in our legal system the “value of life” of a person that is handicapped, disabled, elderly, retired, unemployable is about the same as the family pet – NEAR ZERO… if you are no longer a “maker” and if someone does something that harms you.. there is no “financial damage” and thus our legal system sees no legal claim. Actually if a “taker” is pushed out of the system.. there is a “financial gain” to Medicare/Medicaid/SS or the insurance industry.

Filed under: General Problems | 6 Comments »

US Revives its Harmful Drug War

Attorney General Sessions to Crack Down on Marijuana

https://www.hrw.org/news/2018/01/04/us-revives-its-harmful-drug-war

US Attorney General Jeff Sessions is reviving the US government’s out-of-date, ineffective, and counterproductive war on drugs. Today it was reported that he will rescind the 2013 Cole Memo, which allowed federal prosecutors to choose not to prosecute marijuana offenses in the states that allow adults to consume it.

Expand

Earlier this week, California became the sixth US state to allow recreational use of marijuana for adults. Sessions’ latest action shows that the attorney general wants federal prosecutors to have much less leeway in deciding whether to enforce federal marijuana laws in states like California. At a moment when preliminary US Centers for Disease Control data suggests that 146 people are dying every day in the United States from opioid overdoses, it is difficult to understand why the White House is focusing such energy on marijuana policy. President Donald Trump has yet to nominate directors for either the Drug Enforcement Administration or the Office of National Drug Control Policy.

Sessions’ combined actions will fuel arrests and mass incarceration in states and at the federal level. Every 25 seconds, someone in the United States is arrested for merely possessing drugs.

One in nine arrests at the state level is for drug possession – 1.25 million arrests every year – and they all cycle through the criminal justice system. Human Rights Watch has documented that this massive effort has had negligible impact on drug availability, and has even worsened the harms of drug trafficking and drug dependence. Even though African Americans and whites use drugs at the same rates, African Americans are disproportionately targeted, arrested, and incarcerated for drug offenses. Those incarcerated for drug offenses typically do not have access to drug treatment and can carry a scarlet letter for years, which impedes successful reentry into society by limiting housing and employment options.

Make no mistake, the war on drugs is again underway. It’s now up to Congress to check the Justice Department’s misguided policies by passing legislation to decriminalize possession for personal use of marijuana and other drugs.

Filed under: General Problems | 2 Comments »

Sessions: Opioid Prescriptions at 18-Year Low

www.painnewsnetwork.org/stories/2018/10/25/sessions-opioid-prescriptions-at-18-year-low

AG Session is filing indictment against FOREIGN CITIZENS IN CHINA AND MEXICO and their respective governments are not going to cooperate with those indictments against those people. So Session’s action(s) is nothing but a LARGE SMOKE SCREEN.

Most decline in opioid overdoses but no mention of the increase use/abuse of Methamphetamine, Cocaine, Crack, Marijuana and other substances that substance abusers will find that works for them to help them to GET HIGH.

That 2.3 % decline was based on what number … the 70,000 that the CDC declared is from all drug OD’s are just those that are related to opiates OD… if the later then then reduction could be a couple of hundred – OR LESS.

But is fewer are dying and there is an increase in other substances being abused… then the total “pool” of substance abusers has to be GROWING… many of them are committing crimes to afford to “feed their habit”

Filed under: General Problems | 4 Comments »

End-Of-Life Care Group Reaches Key Benchmarks In Helping Health Care Providers, Communities Statewide Prepare For Medical Aid-In-Dying Law

https://www.news-line.com/PH_news27492_enews

Compassion & Choices Hawai’i today announced that its public education campaign about the Our Care, Our Choice Act has met several key benchmarks in preparation for the law to take effect on January 1, 2019

Compassion & Choices Hawai’i is the local affiliate of Compassion & Choices, the nation’s oldest, largest and most active nonprofit organization committed to improving care and expanding choice at the end of life. For more information call 808-282-8247 or visit www.compassionandchoices.org/Hawaii..

Filed under: General Problems | 5 Comments »