Two new studies, just published in the New England Journal of Medicine, found that established weight-loss surgeries were significantly more effective than other conventional treatments for Type 2 diabetes.

Patients who had the weight-loss surgeries experienced a complete remission of their diabetes, or failing that, needed less medicine than their counterparts who stuck with traditional medical treatments along with diet and exercise. Many of the surgical patients also experienced lower cholesterol levels and blood pressure.

The results were startling: In the first, at the Catholic University in Rome, after two years, two groups of surgical patients had complete remission rates of 75% and 95%. None of the medically controlled patients went into remission.

A second study at the Cleveland Clinic looked at similar groups of patients. Overall, these groups had lower remission rates (partly due to a stricter definition of “remission”). But one year after surgery the two surgical groups had remission rates of 42% and 37%. Only 12% of patients receiving medical treatment went into remission. (Note: Neither study included so-called “lap band” surgery as one of the treatments, because it does not alter the shape of the stomach.)

The studies are the first to scientifically examine the effect — long noticed by doctors working with bariatric surgery patients.

According to the researchers, even though obesity is a known factor in the onset of Type 2 diabetes, the surgeries didn’t control the disease simply by helping patient lose weight. Instead, it seems the anatomical changes to the organs actually changes the levels of various hormones that control how the body metabolizes fat and sugar.

While more effective treatments for diabetes are a godsend for many patients, many experts caution that bariatric surgery comes with its own risks, and isn’t necessarily a good choice for many patients.

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The report cites several disturbing pieces of information, including:

• a 2007 study by researchers at The Cleveland Clinic that claimed Avandia users had a 43% higher risk of heart attacks, and
• a 2008 FDA internal review that led two scientists to recommend Avandia being taken off the shelf.

The recommendation was ignored, although the FDA has asked for a new study to assess the true risk of cardiovascular events among Avandia users. Glaxo has also added a black label warning regarding the potential for serious cardiovascular events.

Who regulates the regulators?

The report gives more ammunition to critics who claim the FDA needs an independent body to review after-market drugs. Currently, once drugs are on the market, any further review is done by a panel which is beneath the division that approves new drugs.

It sets up an essential conflict of interest, because the same section of reviewers who first approved the drug are then asked to re-judge their earlier decisions. FDA officials say it’s the most streamlined way to handle it,  because the people most familiar with the drug are the ones who review it.

Glaxo claims that the increased cardiac risk hasn’t been conclusively proven and that it has merely tried to correct faulty information about its product. The company’s numbers report more than $1.2 billion in global sales of Avandia last year.

Does FDA need a better way to review drugs that are already on the market, or is this much ado about nothing? Weigh in in the comments.

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Memorial Health Care System in Chattanooga, Tennessee has started testing new hires for tobacco use, along with other standard drug tests. Anyone who tests positive will have their job offer withdrawn.

Current workers aren’t affected by the new policy.

The hospital is making the move to provide a healthier environment for workers and patients — and to save the estimated $3,000 to $4,000 per year in health care costs that smokers ring up.

It’s similar to the policy at a handful of other hospitals, including the Cleveland Clinic.

Some critics say the policy is discriminatory — after all, no one is testing to see how much exercise new hires get or if they indulge in too many between-meal chocolate bars.

But even some workers say the prospect of losing out on a job is good motivation to quit.

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Online personal health records based solely on patient inputs have been around for awhile, but few consumers use them. They’re time-consuming and it’s easy for non-professionals to make mistakes in updating the records.

But having centralized records available for every visit, diagnosis and medication — no matter which provider or facility the patient has seen — could have a huge beneficial impact on the diagnosis, prescription management, etc.

So far, major institutions such as the Cleveland Clinic, Kaiser Permanente and the Mayo Clinic have partnered with IT players like Microsoft and Google to test systems that would import individuals’ provider-based health data into their own personal health records.

Now, NewYork-Presbyterian Hospital has launched a program in conjunction with Microsoft to allow consumers access to their info with the goal of allowing them to share that data with health providers at any facility they choose.

The hospital is starting with heart patients, who will be given access to a Web portal for their personal health records.

Pros and cons

Giving patients access to electronic versions of their medical records should help in a number of ways, including improved patient compliance with medications, easier communication between patients and providers as well as between providers at different practices or hospitals. But whether consumer-controlled health records live up to their promise will depend on how well all the stakeholders can ensure that the records are kept up-to-date and that patients understand how to use them.

What’s your take? Will widespread use of patient-controlled health records make providers’ jobs easier, or just make it easier for information to get muddled? Let us know in the comments.

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