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Heart to Heart with Hillary

 
Merck ponders next step for troubled heart drug

Marilynn Marchione

Chicago (AP) - Officials at drugmaker Merck & Co. say they will take more time to decide what to do about an experimental blood thinner that gave disappointing results in a second big study.

The study was aimed at preventing repeat heart attacks and strokes in people who had already suffered one or were in danger of one because of hardened arteries in their legs.

The drug, vorapaxar, lowered the risk of those problems but also raised the risk of major bleeding, including dangerous bleeding in the head, which largely canceled out the drug’s benefit.

Results of the study were discussed Saturday at an American College of Cardiology conference in Chicago and published by the New England Journal of Medicine.

Merck had hoped vorapaxar would become a new, first-of-its-kind blood thinner.

The company-sponsored study involved more than 26,000 patients in 32 countries. All were given usual heart medicines plus aspirin, and half also received daily vorapaxar pills.

Safety monitors stopped part of the study last year after seeing higher rates of bleeding in the head among people with a history of stroke who were on the experimental drug. The study continued in the rest of the participants.

After three years, about 9 percent of those given vorapaxar had suffered a heart attack or a stroke or had died from heart-related causes versus more than 10 percent of those not given the drug. Moderate or severe bleeding occurred in about 4 percent of those on vorapaxar versus just more than 2 percent of the others, said the study’s leader, Dr. David Morrow of Brigham and Women’s Hospital in Boston.

Among those with a history of heart attack - two-thirds of study participants - the drug had a net benefit, though, leaving the possibility that Merck might pursue seeking federal approval to sell it for these patients.

However, several experts not connected with the study said the drug’s relatively modest benefit and likely high cost would make it a tough sell even if it were allowed on the market.

“This is not a drug that I would put in my personal medicine chest,” said Dr. Eduardo Marban of Cedars-Sinai Medical Center in Los Angeles.

Merck officials said they would discuss the results with more scientists before deciding their next steps.

Online:

Heart meeting: http://www. cardiosource.org

New England Journal: http: //www.nejm.org
 



Dear Hillary,
It is amazing all the stories you get when living in a foreign country. It is a debate “them or us”. A foreigner stands no chance. A Thai judge and a Thai lawyer…
Jack

Dear Jack,
You will have seen that the middle section of your letter I did not print as you are making allegations, which I have no intention of exploring or defending; however, you should be very careful when making these sorts of statements. I should not have to remind you that you are a guest in this country. It is easy to point fingers at deficiencies in the laws in any country, but a well-mannered guest does not do so in public.

Dear Hillary,
Since everyone uses emails these days, which are pretty anonymous, how do you know whether the letters you get are genuine? I reckon some of them are using the fact they can hide behind nicknames and the email system to pull your leg. Do you honestly believe everyone who writes to you is real?
The Disbeliever

Dear Disbeliever,
I am an Agony Aunt, not a detective, my Petal. Does it really matter if someone tells a few porkies? I may be na๏ve and old, but I can recognize that behind every nickname there lies a frightened little boy who is having some kind of relationship problem, usually with our young Thai ladies. So, what’s your problem “Disbeliever”? And, not everyone uses emails, as you will see by this letter I received this month.

Dear Hillary,
My husband appears to have a problem, which in turn gives me a problem. He has a tendency to drink heavily at times and then can go into extreme rages. During one of these turns he can do anything - stupid things like breaking windows or kicking down doors and the like. I never know what to do when he gets like this, and neither does any of our friends as a few of them have witnessed it too, and some have refused to go out with us, “just in case.” This has been brewing for some time and it is nothing for him to drink six large bottles of beer before dinner and then a few more after that. Have you any suggestions that I could follow? I did suggest he should see someone about this problem, but when he’s sober he thinks he doesn’t have a problem. He has been a good husband until the past couple of years, but I can’t take much more of this.
Confused and worried

Dear Confused and worried,
You surely do have the cares of the world on your shoulders, but you are probably shouldering more than you should. Unless you are the cause of your husband’s drinking, the main problem revolves around his responses to too much alcohol. Why does he overindulge? Does he admit to the irrational behavior? Is he sorry afterwards, or does he blame someone else - or you? Quite frankly, I think you need to get him to seek professional help and very soon, before he does you, or someone (or even himself) an injury. Just be sympathetic towards his problem, but don’t wear it yourself. He is the one with the problem, not you. Best of luck, but be prepared for an upheaval in your life. This is a very difficult situation.

Dear Hillary,
I read and been told not to touch Thai girl on head because Thai think very rude. What I wanting to know is how do you kiss Thai girl? On the hand?
Wolfgang

Dear Wolfgang,
This is why the Thais have the “sniff-kiss” which is like the “air-kiss” of Europeans, which I expect you know about. Instead of making kissy-kissy noises beside the ear, Thai people make a gentle sniffing sound beside the cheek. Much more romantic.

Dear Hillary,
I have noticed that you do spend much of your weekly columns appealing to your worried clients to send you champagne and chocolates. Do you think this is fair? These people have problems and you dismiss them with a “send chocolates and champagne” answer. What is it with you and the chocolates anyway? Are you envious of us young folk and need a warm comforter?
Not a chocaholic

Dear Not a chocaholic,
You young people are all the same these days - so sure you have the world by the tail and wanting an answer for everything. Some things are just written in the stars, my Petal. Nothing to do with age at all. I suppose you also want to know why the earth is round, when the simple answer is just because it is! Likewise with me and my chocolates. Now, for having read your letter, that’s one chocolate bar. For replying to it that’s another. Remember that not everyone is like you, my little enquirer. I had a lovely man who wanted to build me an Amari Hotel in the front garden of my townhouse who dropped in a beautiful bottle of French wine the other day. Thanks but next time bring one with bubbles! He knows what life’s about, Petal! You’ll get there too - eventually!
 



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