Wake-up call provides new view of tired blood

[okarol]

Wake-up call provides new view of tired blood
 
Canwest News Service
Tuesday, August 12, 2008

Anemia or ''tired blood'' caused by chemotherapy, dialysis or heart disease might help heal the body rather than harm it, says a study that challenges the need for a $9-billion-a-year drug.

The study, published in the Canadian Medical Association Journal, suggests millions of patients with anemia stemming from chronic disease are being dangerously overtreated.

In many cases, the treatments could increase risk of death, said Ryan Zarychanski, the study's co-author and scientist at the Ottawa Health Research Institute.

"Doctors have been taught for generations that anemia is bad and they want to help their patients by treating it," he said. "But we failed to consider this response may be adaptive and may be exactly the response that the body needs at that time."

"Tired blood" involves a shortage of healthy red blood cells to carry oxygen to the body tissues.

In the past, blood transfusions were the only way to treat anemia. More recently, transfusions have been replaced by a best-selling drug derived from erythropoietin. But studies have raised questions about whether erythropoietin, or "epo," might actually make underlying illnesses worse.
© The Gazette (Montreal) 2008

http://www.canada.com/montrealgazette/news/story.html?id=0f53123c-fa46-4c63-8fd8-b7c40e249b91

[stauffenberg]

There is a huge political movement by the right-wing in the US to conduct a scare campaign against EPO in order to allow them to cut back on EPO dosing for profoundly anemic dialysis patients and thus save money for rich, healthy taxpayers.  While transient anemia may be a normal response of the body to certain states of illness and might have some adaptive role a those times, anemia is not a normal state of the body, since otherwise a million years of evolution would not have established an Hb value of 140 for men and 120 for women as the norm.  Any expenditure of energy by the body lowers its ability to endure environmental stress, since energy expenditure makes it more vulnerable to starvation, which for most of human evolution was a major threat determining who survived and who did not.  Since it requires energy to maintain hemoglobin at 140 or 120, there is no way on earth that evolution would have set those as the normal values the human body expends energy to maintain were they not necessary for optimal functioning.

What is disease?  Obviously it is any non-optimal functioning of the human body.  Since people with anemia have low endurance, lack of energy, abnormal sleepiness, constant tiredness, lack of libido, and an inability to think clearly, anemia has to be regarded as a disease state.  Since the muscles are deprived of oxygen in anemic patients, especially the heart, this is hardly a state conducive to long-term health.  Diabetic retinopathy is itself a condition caused by overgrowth of fragile capillaries on the retinal surface to compensate for poor oxygenation, so even that condition, found in about 40% of dialysis patients, would be made worse by anemia, due to the lack of red blood cells to carry oxygen.

In short, this whole article is nonsense.

[pelagia]

While I am not disagreeing about the drug industry in general, it looks like this study was published by Canadians in a Canadian journal.  I know the Canadians generally don't like to lose their identity to the US.
 
Also, this site provides additional text to the story posted at Okarol's link, including more discussion of the possible negative effects

http://www.canada.com/topics/news/story.html?id=b716c8f2-4407-4f39-8de4-a4d1ca8b4cce

"But recent studies have raised questions about whether erythropoietin, or "epo," might actually make underlying illnesses worse. A study published last year in the New England Journal of Medicine found that patients with kidney failure who were treated aggressively with the drug had higher risks of heart problems and death than those treated less aggressively. (note: this is where the earlier article ended the story)

Another study in the Journal of Clinical Oncology described a small Canadian trial in lung cancer patients that was stopped because those getting epo were dying sooner.

Following the studies, the U.S. Food and Drug Administration issued an alert to cancer doctors and announced it would review the drug, sold under the brand names Epogen, Procrit and Aranesp. Worldwide sales of the drug, made by Amgen, Roche and Johnson & Johnson, top $9 billion.

When Zarychanski reviewed the existing medical research more closely, he discovered that efforts to treat anemia caused by chronic disease often do more harm than good. He pointed to evidence that suggests anemia is an evolutionary response to illness, occurring not just in humans, but in horses, dogs and zebra fish.

"The body has adapted over thousands of years to be anemic at times of stress because it needs to conserve energy," said Zarychanski. "It needs help to fight infection. And when you're anemic, bacteria doesn't grow so well in the blood. It's probably an evolutionary response to infection before we had antibiotics."

In general, healthy adults have red-blood-cell levels of 14 grams or more per 100 millilitres of blood, while patients are considered to need treatment if their levels are below 10 grams. Zarychanski argues patients with mild to moderate anemia - those with levels between 10 and 14 grams - would be better off not being treated.

"We should exercise some caution when thinking the best treatment is to automatically transfuse or give drugs to correct anemia," he said."

© Ottawa Citizen 2008

[stauffenberg]

It's been known for a long time that if you try to normalize a chronically ill patient's hemoglobin with EPO, then the risk for heart attack and stroke become dangerously high.  But still, there is nothing healthy in living in a state of perpetual exhaustion either, and anemia does its own damage to the body, since red blood cells are needed to carry oxygen necessary for life.  Fear of the danger of stroke and heart attack  led to the practice by the mid-1980s of keeping dialysis patient's hemoglobin around 120 for males and 110 for females, which while not perfect, are at least tolerable levels at which a human being can accomplish something with his or her life.  However, the latest round of attacks on EPO seeks to go even further towards accepting more serious, long-term damage to the body and imposing more exhaustion on the patients from severe anemia, just to stay clear of the danger zone starting in the upper 120s.  Obviously the clinician has to strike the right balance between the two extremes of exhaustion and deoxygenation on the one hand and stroke and heart attack on the other, but lately the advice is going too far in favor of anemia.  For my own life, I would prefer 10 productive years at a hemoglobin of 120 to 20 unproductive years at 100.