Biomedical subjects

R I Shorr

Publications and source records attributed to R I Shorr.

40 records · Page 3Linked to original sources

PubMed1981

Laetrile: a survey of judicial and administrative activity.

The judicial and executive branches of the federal government, motivated by emotionalism, political pressure, and a self-appointed need to placate the National Cancer Institute, have reached a decision on laetrile that weakens the legal protection of the general public. Recent approval of clinical trials of laetrile by the Food and Drug Administration was not consistent with policies adopted earlier, nor was it warranted by federal court decisions.

Amygdalin↗

PubMed1979

Laetrile: end play around the FDA. A review of legal developments.

We consider here some of the legal and political background behind today's laetrile controversy. First, we provide a brief historical review of our present food and drug legislation and discuss details of these laws with respect to attempts by laetrile's backers to use the courts in the legalization of this compound. We analyze one case, Rutherford v. United States, that was won in the lower courts by the advocates of laetrile and conclude that the courts may have allowed emotionalism to interfere with the process of rational decision-making. On a larger scale, this emotionalism manifests itself as political pressure that may bring about changes in our food and drug legislation. These changes could loosen restrictions on the effectiveness requirement and result in the sacrifice of consumer protection in favor of making available more drugs, some of them ineffective, from which the patient may choose for treatment.

Amygdalin↗

PubMedDate not supplied

Glycemia and cognitive function in older adults using glucose-lowering drugs.

OBJECTIVES: In experimental studies, both high and low levels of plasma glucose are associated with cognitive impairment. In populations, less is known about the relationship between glycemia and cognitive function, especially in persons using glucose-lowering drugs. DESIGN: A cross-sectional study of 378 high-functioning black and white men and women aged 70 to 79 participating in the Health, Aging, and Body Composition Study (Health ABC) who used glucose-lowering medications. Glycemic measures included fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c). Cognitive function was assessed using the Modified Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSS) at the same examination visit in which the glycemic measures were determined. SETTING: Memphis, Tennessee and Pittsburgh, Pennsylvania. RESULTS: We observed an "inverted-U" relationship (p =.0025 for 3MS, p=.0277 for DSS) between FPG (range 47 - 366 mg/dl) and performance on these two tests. The fasting plasma glucose levels associated with the highest score on the 3MS was 180 mg/dl and 135 mg/dl for the DSS. There was a monotonic inverse relationship between HbA1c and performance on 3MS and DSS without evidence of a threshold effect. CONCLUSION: Our findings suggest that older adults who are treated for diabetes may experience a small degree of cognitive impairment within the recommended fasting glucose levels, yet measures of long-term glycemic control support tight glycemic control. Given the high prevalence of diabetes and the common use of glucose-lowering drugs in older adults, further studies are needed to elucidate these relationships.

Aged↗

PubMedDate not supplied

Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas.

BACKGROUND: Our knowledge about the risk of hypoglycemia associated with diabetes treatment is derived from studies that often exclude frail, elderly persons. OBJECTIVE: To determine the incidence and risk factors for developing serious hypoglycemia among older persons using sulfonylureas or insulin. METHODS: We conducted a population-based, retrospective cohort study of 19932 Tennessee Medicaid enrollees, aged 65 years or older, who used insulin or sulfonylureas from 1985 through 1989. The main end point was serious hypoglycemia defined as a hospitalization, emergency department admission, or death associated with hypoglycemic symptoms and a concomitant blood glucose determination of less than 2.8 mmol/L (< 50 mg/dL). RESULTS: We identified 586 persons with a first episode of serious hypoglycemia during 33,048 person-years of insulin or sulfonylurea use. The crude rates (per 100 person-years) of serious hypoglycemia were 1.23 (95% confidence interval [CI], 1.08-1.38) in users of sulfonylureas and 2.76 (95% CI, 2.47-3.06) among insulin users. Recent hospital discharge was the strongest predictor of subsequent hypoglycemia in older persons with diabetes. The adjusted relative risk of serious hypoglycemia occurring in days 1 through 30 after hospital discharge was 4.5 (95% CI, 3.5-5.7) compared with the risk associated with a hypoglycemic event occurring 366 or more days after hospital discharge. Other independent risk factors included advanced age (relative risk, 1.8; 95% CI, 1.4-2.3), black race (relative risk, 2.0; 95% CI, 1.7-2.4), and use of 5 or more concomitant medications (relative risk, 1.3; 95% CI, 1.1-1.5). CONCLUSIONS: In this population, the incidence of serious hypoglycemia is approximately 2 per 100 person-years, suggesting that many older adults can be safely treated with hypoglycemic drugs. Frail, elderly persons--the oldest-old, those using multiple medications, and those who are frequently hospitalized--are at a higher risk for drug-associated hypoglycemia. Such individuals may benefit from intensive education about the symptoms of hypoglycemia and close monitoring for adverse events related to diabetes treatment.

Age Factors↗