Category Archives: rubbish

Tidal wave required


Ok so life is interesting in south africa. I would like the kind of money that Manyi  has, 450 million? was it. I would use it to “fund” my patients needs.

Diabetics, type 1’s in particular have many needs. Most of these are not taken care of by their medical aids and despite the fact that patients pay a LOT of money for the privilege of being on one.

Type 1’s require tight control of glucose above a certain range and below a certain range and everything including the weather impacts on blood sugar. Thus continuous monitoring is a tool that can make a very very big difference in a patient’s life – it can also make such a difference that the medical aid is spared costs of admissions for highs and lows, for amputation, renal dialysis, heart attacks as well as costs attached to being blind.

However medical aids at large do not seem the slightest bit interested in saving themselves money.

Far rather milk the patient for all they are worth and at the same time provide the minimum service and complain about any request made by the health care provider who has studied long and hard and has a passion to save the medical aid costs.

Yes I am angry, perhaps at this time of day I am even h”angry”.

I am tired of begging, pleading for minimum standards of care.

I am tired that overseas things get “accepted” years before they do in south africa. Are we really 3 rd world? Despite having the “Manyi’s” ???

We require a tidal wave of protest in the form of intelligent debate with the stakeholders that matter in the realm of diabetes. I am just so tired of fighting.

Please from far and wide across  this beautiful country we call home join me, join the debate, write to your medical aid. Email me : drleethegp@gmail.com.

Please.

Continous monitoring is available in 4 forms in south africa : dexcom G5 and G4, libre flash abbott, medtronic standalone CGM and most new to the scene : ever sense.

Coming in at the lower end is the abbott flash R990 once off and R990 every 2 weeks. Dexcom is a cost upfront more than about 25k and then monthly around 4 k, medtronic around 15 and 2k per month and ever sense brand new so not too sure but in the ball park for the last 2 mentioned.

What is boils down to is MARD and quite frankly this is the bottom line with CGM is accuracy. The lower the MARD the more accurate. There are really only 2 in the market that a great on MARD : dexcom G5 and ever sense, however for the cost the libre is actually a very good value for money.

The other thing that helps me as a practitioner is a trend and all of the devices are good for this.

What we need is for the medical aids to realise that CGM is a tool they their patients can NOT afford to be without! FOR THEIR own sakes – the medical aid’s sakes.

Please tsunami arrive and let’s flood the medical aids with the truth.

Alternatively could the guptas or the Manyi’s or maybe Grace Mugage give me 450 million to spend on my very deserving patients.

Thanks ;).

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“Sugar” tax


One of the very few things our government have proposed this year that will have an excellent “effect” on its citizens in so many ways is the sugar tax. I could not honestly have come up with a better idea myself.

Is sugar the devil ? Indeed. If you would like to argue – honestly look around you and use that brain hiding between your two ears. Sugar is the devil in so many many ways. Reeking havoc with our children, learning, society, body image, depression, suicide, waste of resources. I could go on.

One hundred years ago – apparently – we consumed a LOT less sugar per day. These days we just pile it on in all forms breakfast, snack, lunch, snack and then supper some more. We exercise less, we eat more, we spend far less time “resting” and “relaxing”. We work too hard and to sustain it we use sugar. This is a toxic mix.

Not only a logarithmic rise in type 2 diabetes from children to the elderly, but a sharp rise in heart disease, cancer and a few other killers.

Our government – perceptive as they are – propose we try and curb the abuse of sugar by taxing it. Clever on two counts. If you insist on munching continuously you will be taxed and it will hurt your pocket, but also it will fill the government coffers.

I wish people would rub the sleep out of their eyes and stop the madness. Sugar is the devil. Wake up : exercise, eat vegetables, drink water, rest, relax, LIVE. Live a quality life.sugardevil

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Statins are NOT satan, indeed the contrary!


satan2statins2Ok, so I am not Tim Noakes, neither am I a professor of medicine – though I have listened over the past 20 years to many of them and do on an ongoing basis. They as a whole (generalisation) tend to speak from journals and science. Science these days has to be proven quite well.

There is honestly so much rubbish on the internet from the absolute hogwash about statins to the dribble about vaccines.

LEt’s talks science and let’s talk LIFE quality and quantity.

No I am not a professor but I aim to give my patients the absolute best I can.

What do we know? We know that the diabetes/cardiovascular (another way of saying heart attacks) epidemic is growing on a log curve (if that does not shock you look up what a log curve is). It is not stopping, on the contrary it is snowballing. Why?

Multi-factorial.

What do we know from science and trials like Jupiter – these are big (100 000s) patients across continents. The long and the short is that if your number – LDL is at target (2.8 mmol/l) you will NOT have a heart attack and you will NOT have a stroke.

Now think about this for a minute, would you rather have a heart attack/stroke or would you rather have a bit of muscle ache? Not so bad if the heart attack takes you – although bad for the family. But a trainsmash if you are “maimed” by it, especially when we KNOW it is preventable.

WE have so many statin trials that it is unethical to have one arm on a statin and one arm off a statin – that’s how strong the evidence is as we KNOW the non-statin arm will have “events”.(Secondary prevention).

I am also not a huge fan of big pharma and whilst various conspiracy theories exist in this regard. This is not a conspiracy. This is indeed science.

“Statin therapy is effective at reducing cardiovascular event rates among those with prior myocardial infraction, stroke, diabetes, or overt hyperlipidemia, and current guidelines strongly recommend lipid-lowering therapy among these patient groups as an adjunct to aggressive lifestyle interventions. However, of the nearly 1.7 million heart attacks and strokes that occur annually in the United States, more than half occur among apparently healthy men and women with average or low levels of cholesterol. Thus, novel screening and treatment strategies for cardiovascular prevention are needed that can detect high vascular risk in the absence of hyperlipidemia, that are inexpensive and simple to implement in the primary care setting, and that can provide comparable or superior effectiveness compared to currently accepted approaches”. This is the opening paragraph of Jupiter. What jupiter was trying to ascertain is whether primary prevention is worth doing.

The results ? “Finally, in terms of net clinical benefit, when a composite end point of a first cardiovascular event, venous thromboembolism, or death from any cause is considered, the 5-year NNT in JUPITER was 18.13“”Current guidelines for statin therapy emphasize the need to achieve specific LDLC goals to maximize benefit. However, statins reduce hsCRP in a largely LDLC independent manner, and in the CARE,10 PROVE IT – TIMI 22,9 A to Z,11 and REVERSAL21 trials, best clinical outcomes in terms of event reduction or atherosclerotic regression were observed among those who not only reduced LDLC, but who also reduced hsCRP. Specifically, in these studies, the lowest clinical event rates were consistently seen among those who not only achieved LDLC levels <70 mg/dL, but who also achieved hsCRP levels <2 mg/L. Although these findings are consistent with laboratory evidence indicating antiinflammatory properties of statin therapy as well as current pathophysiologic understanding that atherothrombosis is a disorder of inflammation as well as hyperlipidemia, the concept “dual targets” for statin therapy remains controversial.22

“JUPITER not only confirms that men and women with elevated hsCRP and low LDLC are at substantial vascular risk, it demonstrates that statin therapy can cut that risk by half. Simplified guidelines that advocate combined lifestyle and pharmacological therapy in those groups where trial evidence clearly supports a net benefit have the potential to greatly improve patient care and public health.”

I have specifically quoted Jupiter verbatim as I am so tired of unsubstantiated claims in this regard and I would urge all the statin haters to read the science and chat to the professori of our times. The professori at large.

Statins are not the devil indeed if you are a loved one they may be the saviour. The saviour in terms of preventing a death or a person that now has to be “cared” for. The saviour of our failing medical system that does not need the added burden of cost of multiple patients with stroke and heart attack. Look up how much the average cost to medical aid (or patient if not on one) a heart attack/stroke costs in money terms. Then think about that cost in emotional/psychological terms. Then just have a little think about the vast body of science for a longer while than it takes to read some pathetic unsubstantiated claim on the vast body of internet rubbish. The choice really is yours, the answers are there if you look for them properly.

Circulation: Cardiovascular Quality and Outcomes.2009; 2: 279-285doi: 10.1161/CIRCOUTCOMES.109.868299statinsstatins2