Friday, April 14, 2006
Some hopeful news on this Holiday weekend, Slate.com reports
"A girl's failing heart healed itself while she used a donor heart. Ten years ago, when she was a toddler, her heart was too big and weak, so doctors gave her a donor heart but left the original one inside her, still connected. Recently, her body rejected the donor organ, and when they opened her up, they found that the original organ had fixed itself. Reactions: 1) It's a miracle. 2) It's a tribute to the doctors who left the original heart inside her, just in case. 3) It validates the theory that some failing hearts suffer from inflammation and can recover if simply allowed to rest."
Here is a great post found on Reason.com on the alledy dangers posed by the abortion pill, Ru-486:
The abortion pill has never made for polite dinner conversation, but the discussion has grown particularly unpleasant since women started dropping dead. In mid-March, citing two new incidents, the FDA put the pill's possible death toll at six. Senator Jim DeMint (R-S.C.) calls Mifepristone a "deadly drug that kills pregnant women," Rep. Chris Smith (R-N.J..) calls it a "a classic case where the politics of abortion has trumped women's health," and American Life League President Julie Brown simply asks "How much longer must we tolerate such insanity?"
Not much longer, if Congressmen in both houses have their way. In March, legislators in both houses revived the RU-486 Suspension and Review Act, a golden oldie from '03, which would force the FDA to withdraw the drug.
The debate has carried the rhetoric of a public health scare into the abortion debate, but the battle lines are etched into familiar ideological territory. Touting the drug's toxicity are abortion opponents, while Planned Parenthood swears by its safety. Both sides are accusing the other of mixing morals and medicine: Abortion opponents say that if the drug were not a P.C. touchstone, it would have been yanked years ago, while pro-choicers claim the religious right's concern for women's health is pure smokescreen.
The entire article is worth a read. I really dislike all the politcs that seem to outweigh the science in the health arena these days. Thanks to the Washington Monthly for the heads up on this post. [bm]
Thursday, April 13, 2006
Erza Klein reports on a new study found in the New England Journal of Medicine (unfortunately not available for free) that reminds us again how unhealthy fast food, which contains many grams of trans fat, is for us. It turns out that not only is fast food food unhealthy, but it is particularly unhealthy here in the United States because it contains even more of those unhealthy trans fats. According to the study, as reported by the Associated Press's Linda Johnson:
Order french fries or hot wings at a McDonald's or a KFC in the United States and you're more likely to get a super-sized helping of artery-clogging trans fats than you would be at their restaurants in some other countries.
A study of the fast-food chains' products around the world found remarkably wide variations in trans fat content from country to country, from city to city within the same nation, and from restaurant to restaurant in the same city.
The researchers said the differences had to do with the type of frying oil used, and the main culprit appeared to be partially hydrogenated vegetable oil, which is high in trans fats.
“I was very surprised to see a difference in trans fatty acids in these uniform products,” said one of the researchers, Dr. Steen Stender, a cardiologist at Gentofte University Hospital in Hellerup, Denmark, and former head of the Danish Nutrition Council. “It's such an easy risk factor to remove.” . . .
At a New York City McDonald's, a large fries-and-chicken-nuggets combo was found to contain 10.2 grams of the trans fat, compared with 0.33 grams in Denmark and about 3 grams in Spain, Russia and the Czech Republic.
At KFCs in Poland and Hungary, a large hot wings-and-fries order had 19 grams of trans fats or more, versus 5.5 grams for wings and fried potato wedges in New York. But in Germany, Russia, Denmark and Aberdeen, Scotland, the same meal had less than a gram.
A large order of french fries at a New York City McDonald's contained 30 percent more trans fat than the same order from an Atlanta McDonald's.
No wonder we have an obesity problem here. [bm]
The New England Journal of Medicine has a great article on post-Katrina health care in New Orleans. The article is entitled, "After the Storm - Health Care Infrastructure in Post-Katrina New Orleans, authored by Ruth E. Berggren, M.D., and Tyler J. Curiel, M.D., M.P.H. Here is a brief excerpt:
Although many citizens have yet to return, area hospitals are scrambling to meet local needs. The population of metropolitan New Orleans is approximately 24 percent smaller than before the hurricane, but only 15 of 22 area hospitals are open, with 2000 of the usual 4400 beds. According to data from the Times-Picayune, before the storm, New Orleans had only 3.03 hospital beds per 1000 population, as compared with the average of 3.26 per 1000 for U.S. cities; today, there are 1.99 per 1000. "The number one current problem is total hospital capacity," says Joseph Uddo, chief of general surgery at East Jefferson General Hospital in neighboring Jefferson Parish. "Emergency department patients can't move into the hospital because beds aren't available. We have no surge capacity."
Moreover, open hospitals must deliver ever greater amounts of uncompensated health care. Patrick Quinlan, chief executive officer (CEO) of the Ochsner Clinic Foundation, says uncompensated care in his facility has tripled since Katrina. "Many people have lost their jobs, and we have throngs of transient workers in town without health insurance," reports Les Hirsch, CEO of Touro Infirmary. Reimbursement for uncompensated care has yet to come, and, Hirsch notes, there is "a huge debate regarding how best to have uncompensated care dollars follow the patients, rather than following the hospitals."
Common themes at all facilities include complications in patients with untreated chronic diseases, particularly hypertension, diabetes, and AIDS (see box). "These people come in with extremely severe problems," notes Alfred Abaunza, chief medical officer of West Jefferson Medical Center. "Diabetics have been off their insulin for six months. They come to us in diabetic ketoacidosis."
Many believe that mortality has also increased substantially, although specifics are difficult to obtain — the Louisiana Department of Health is still struggling to complete the compilation of 2005 data. As a crude indicator, there were 25 percent more death notices in the Times-Picayune in January 2006 than there were in January 2005. Stress exacerbating underlying health problems is blamed for some deaths. Post-traumatic stress disorder and suicide remain tangible public health issues. There are insufficient numbers of mental health facilities and care providers to deal with the crisis.
The entire article is an eye-opening read into the many issues that face the medical community in New Orleans. It is available free at the NEJM website and there is an additional audio file containing an interview with the authors here. Thanks to JIm Tomasewski for the heads up on this website. [bm]
Wednesday, April 12, 2006
BBC News has an article reporting on a study which critiques pharmaceutical companies (everyone's favorite target these days) for allegedly inventing diseases to make a profit. Here is an excerpt:
Disease-mongering promotes non-existent diseases and exaggerates mild problems to boost profits, the Public Library of Science Medicine reported.
Researchers at Newcastle University in Australia said firms were putting healthy people at risk by medicalising conditions such as menopause.
But the pharmaceutical industry denied it invented diseases.
Report authors David Henry and Ray Moynihan criticised attempts to convince the public in the US that 43% of women live with sexual dysfunction.
They also said that risk factors like high cholesterol and osteoporosis were being presented as diseases - and rare conditions such as restless leg condition and mild problems of irritable bowel syndrome were exaggerated.
The report said: "Disease-mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.
Tuesday, April 11, 2006
For your information:
The Lewis Walker Institute recently hosted three days of programming around
Stolen Childhoods, a feature-length documentary on global child labor that
examines the plight of 246 million poor and exploited working children around the world. Told from their vantage point, the film enters the world of children who are enslaved, abducted, sexually exploited, starved, and/or forced to work under the worst possible conditions. Their youth stolen, these children of color are denied education and deprived of their innocence, in many cases, by industries
which rely upon child labor to keep production costs low and profits high. Lest we think that the destruction of young lives is confined to urban centers or is a remote problem about which we can do little, the final segment of Stolen Childhoods, filmed in rural Texas, reveals the impact of
labor exploitation on American children who cannot attend school as long as there are crops to be harvested. In that seasonal labor is a vital element of American agricultural economy, and the exploitation of Hispanic laborers is a social and political concern of moment, we must ponder the many new ways racism presents itself as we also consider how to improve the lives of
children of color at home and abroad. . . . .
For your convenience, I have included a link to the Stolen Childhoods
Finally, this program comes with my highest recommendations. I hope you
will consider showing Stolen Childhoods at your school or community
organization in the near future. Please call upon me if I can provide you
with further information about this important film.
Educating head, heart, and hand,
Deborah H. Barnes, Ph.D.
Associate Professor of Africana Studies
Lewis Walker Institute for the Study of Race and Ethnic Relations Welborn
Hall Mail Stop: 5236 Western Michigan University Kalamazoo, MI 49008
Monday, April 10, 2006
William Saletan at Slate.com writes a brief article about the latest research concerning obesity (most obese people fail to realize that they qualify as obese). He states,
In a study, they (obese individuals) accurately calculated their height and weight but classified themselves as overweight, not obese. By contrast, more than 70 percent of overweight and normal-weight people accurately classified themselves. Interpretations: 1) Fat people don't know the numerical threshold of obesity. 2) They know it but don't want to admit they're fat. 3) We're getting so fat we've lost all perspective on what fat is. (For Human Nature's previous update on our slipping standards of fatness, click here.)
Saletan has other interesting health-related articles posted at the Human Nature section of Slate.com.
Tonight, your local PBS station will mostly likely be showing, "The Boy in the Bubble" as part of the American Experience series. It looks to be an interesting program that will discuss some of the complex ethical issues raised by the boy with no immune system and the medical treatment he received. From the PBS website,
When David Vetter died at the age of 12, he was already world famous: the boy in the plastic bubble. Mythologized as the plucky, handsome child who had defied the odds, his life story is in fact even more dramatic. It is a tragic tale that pits ambitious doctors against a bewildered, frightened young couple; it is a story of unendingly committed caregivers and resourceful scientists on the cutting edge of medical research. This American Experience raises some of the most difficult ethical questions of our age. Did doctors, in a rush to save a child, condemn the boy to a life not worth living? Did they, in the end, effectively decide how to kill him?
Sunday, April 9, 2006
A Reuters report informs us of recent studies showing that certain spices may help kill certain cancers. According to the report,
Ginger can kill ovarian cancer cells while the compound that makes peppers hot can shrink pancreatic tumors, researchers told a conference on Tuesday.
Dr. Rebecca Liu, an assistant professor of obstetrics and gynecology at the University of Michigan Comprehensive Cancer Center, and colleagues tested ginger powder dissolved in solution by putting it on ovarian cancer cell cultures.
It killed the ovarian cancer cells in two different ways -- through a self-destruction process called apoptosis and through autophagy in which cells digest themselves, the researchers told a meeting of the American Association for Cancer Research.
"Most ovarian cancer patients develop recurrent disease that eventually becomes resistant to standard chemotherapy, which is associated with resistance to apoptosis," Liu said in a statement.
"If ginger can cause autophagic cell death in addition to apoptosis, it may circumvent resistance to conventional chemotherapy."
and for those of you who prefer to spice up food with chili peppers:
A second study found that capsaicin, which makes chili peppers hot, fed to mice caused apoptosis death in pancreatic cancer cells, said Sanjay Srivastava of the University of Pittsburgh School of Medicine.
"Capsaicin triggered the cancerous cells to die off and significantly reduced the size of the tumors," he said.
The spicy compound killed pancreatic tumor cells but did not affect normal, healthy pancreas cells, researchers told the AACR meeting.
Last year the same team reported similar results with pancreatic cells in lab dishes. Pancreatic cancer is highly deadly, killing 31,000 of the 32,000 it will be diagnosed in this year.
Last month researchers in Los Angeles reported that capsaicin killed prostate tumor cells. Other studies have shown that turmeric, a yellow spice used widely in Indian cooking, may help stop the spread of lung cancer and breast cancer in mice.
Of course, keep in mind that:
Experts point out that many compounds shown to stop cancer in mice are not nearly as effective in human cancer patients.
Thanks to Pandagon for the website! [bm]
If you have an interested in following some of the more recent debates concerning health care reform and the Medicare part D program, you may want to check out Drug Bill Debacle at the TPMCafe. It has many terrific contributors and provides great perspectives on some of the health policy issues of today. [bm]
Friday, April 7, 2006
Majikthise, one of my favorite bloggers, has posted a history of emergency contraception. She states,
Scientifically validated emergency contraception (EC) didn't exist until 1974. Dr. Albert Yuzpe, a Canadian OB-GYN, developed and tested the first EC regimen in 1974. Planned Parenthood explains:
The ECP regimen first approved by the U.S. Food and Drug Administration (FDA) is called the Yuzpe Regimen, named for Canadian Professor A. Albert Yuzpe who, in 1974, published the first studies demonstrating the safety and efficacy of ECPs. The Yuzpe regimen consists of combined oral contraceptive pills that contain the hormones estrogen and progestin taken in two doses Our story begins in 1974 when emergency contraception was as innovative as rocket science.
The FDA declared the Yuzpe regimen safe and and effective in 1997 and approved an Yuzpe-based EC kit in 1998. Plan B got FDA approval in 1999.
The drug marketed under the name "Plan B" is a major advance on the Yuzpe regimen. Plan B is the first progestin-only emergency contraceptive pill on the US market.
As you know, the FDA denied over-the-counter status for Plan B in late 2003. She provides some updated history of where the controversy is now. [bm].
The blog, TigerHawk, has an interesting article on how the FDA and our regulatory system views the harms that drugs cause as compared to the benefits that those same drugs may achieve. The article is entitled, "The FDA, the Tysabri conundrum, and our cultural incapacity for single payor healthcare. The article quotes extensively from a piece in today's Wall Street Journal concerning the FDA and MS that requires a paid subcription. The blog writer states,
One of the biggest problems with our system for regulating pharmaceuticals is that we carefully measure all the harm a drug may have done, but do not weigh against it all the good it certainly can do. This asymmetry between sins of commission, which both the FDA and the tort system consider grave, and sins of omission, which neither take into account in any systematic way, means that it is very difficult to gain the approval of drugs that may do tremendous good for virtually all patients, but grievous harm to a tiny percentage of the people who take them. The risk to the tiny percentage overwhelms the benefits to the millions in the minds of risk averse bureaucrats, and the FDA prevents or delays the approval of the drug.
An example of this is the FDA's hanky-twisting over the multiple sclerosis drug Tysabri, which is orders of magnitude more effective against that nerve-killing disease than existing therapies. Unfortunately, Tysabri has been "linked" -- tenuously, at best -- with a rare brain infection in fewer than five patients out of the many thousands who have taken it. The FDA pressured Biogen and Elan to pull the drug last year, and it has not cleared the drug for relaunch notwithstanding the unanimous recommendation of a non-binding expert advisory panel. Why? Because it fears the quick death of one or two people more than it values the lifespans of hundreds of thousands of people.
The Government Accountability Office (formerly the General Accounting Office) is a wonderful source of information about how the government works (and a frequent source of story ideas for CBS' "60 Minutes"). And because most reports are the result of Congressional queries, they are some indication of what is on Congress' mind, as well. Here are the health-related reports released in March 2006:
- Health Information Technology: HHS is Continuing Efforts to Define a National Strategy. GAO-06-346T, March 15, 2006 (17 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-06-346T
- Health Professions Education Programs. GAO-06-55, February 28, 2006 (42 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-06-55
- Long-Term Care Insurance: Federal Program Compared Favorably with Other Products, and Analysis of Claims Trend Could Inform Future Decisions. GAO-06-401, March 31, 2006 (52 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-06-401
- Medicaid Integrity: Implementation of New Program Provides Opportunities for Federal Leadership to Combat Fraud and Abuse. GAO-06-578T, March 28, 2006 (15 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-06-578T
- Medicare Durable Medical Equipment: Class III Devices Do Not Warrant a Distinct Annual Payment Update. GAO-06-62, March 1, 2006 (19 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-06-62
- Medicare Payment: CMS Methodology Adequate to Estimate National Error Rate. GAO-06-300, March 24, 2006 (42 pages). http://www.gao.gov/docdblite/details.php?rptno=GAO-06-300
Thursday, April 6, 2006
According to the Hill.Com, Senate democrats are pursuing a new strategy with regard to the abortion issue - to try to reduce the need for abortions through greater access to contraceptives. The article states,
The Prevention First Act is sponsored by Senate Minority Leader Harry Reid (Nev.), one of few congressional Democrats considered anti-abortion. The bill, which Reid introduced at the start of the Congress, has the support of Sen. Hillary Rodham Clinton (D-N.Y.), presumptive front-runner in the 2008 presidential primary and 21 other Democrats.
The bill would prohibit group health plans from excluding contraceptive drugs, devices and outpatient services if they cover the cost of other prescription drugs and outpatient services. It would also require the secretary of health and human services to disseminate information on emergency contraception to healthcare providers and require hospitals receiving federal money to provide emergency contraception to victims of sexual assault.
The bill would also mandate that federally funded programs provide information about contraceptives that is medically accurate and includes data on health benefits and failure rates.
When asked whether he would be able to get a vote on his bill soon, Reid said: “I hope so. I’ll do what I can.”
He added that bringing the issue to the floor is “on my mind.”
A Democratic leadership aide said that, while only a slim majority of voters favor abortion rights, an overwhelming majority support promoting the use of contraceptives and comprehensive sex education.
Thanks to Americablog for the cite.[bm]
Thanks to Americablog for the cite.[bm]
Wednesday, April 5, 2006
NPR.ORG has a great story on the latest Merck/Vioxx verdict. Click here to listen. Here is the brief write-up to the story:
A New Jersey state court jury has awarded $4.5 million in a lawsuit filed by men who had suffered heart attacks while taking Vioxx, made by Merck & Co. The trial involved two plaintiffs, John McDarby, 77, and Thomas Cona, 60.
In its split decision, the jury said Vioxx was responsible only for McDarby's heart attack, not Cona's. Cona said he had taken the drug for 22 months, but he could only produce prescriptions that proved seven months of use. He said he used samples the rest of the time.
The award of $4.5 million to McDarby is for compensatory damages. On Thursday, the jury will decide whether Merck should face punitive damages as well.
The jury also found that, under New Jersey consumer-fraud law, Merck misrepresented Vioxx's risks when it marketed the drug to physicians. Merck is accused of intentionally suppressing or omitting material information about Vioxx's risks in its marketing to doctors.
Merck faces a class-action lawsuit in a case brought by a New Jersey labor union that provides health benefits to its members.
Not good news on the desire to improve patient safety and general health care quality, according to a recent study released from HealthGrades, a leading healthcare rankings company. A press release concerning HealthGrades annual report, states,"Patient safety incidents in American hopsitals grew from 1.18 million to 1.24 million aong the 40 million hospitalizations covered under the Medicare program and incidents varied widely from state to state and among the best and worst hospitals."
You should read the full report for the rest of the findings. None of which appear to be terribly uplifting. Thanks to the HealthyPolicy blog for this information. The HealthyPolicy blog also has further helpful comments. [bm]
The papers are all abuzz this morning about the passage of a near-universal coverage law in Massachusetts yesterday. Here are some links:
- Bloomberg News
- Wall Street Journal
- Boston Globe
- Health Care Conference Report
Tuesday, April 4, 2006
The Washington Post reports on an interesting new scientific development that may help with the organ donor shortage in the United States - a development that does not rely on embryonic stem cells. According to the Post,
Researchers said yesterday that they have grown complete urinary bladders in a laboratory and transplanted them into patients, improving their health and achieving a Holy Grail of medicine: the first cultivation of working replacements for failing solid organs in people.
The "neo-bladders," each one grown in a small laboratory container from a pinch of a patient's own cells, have been working in seven young patients for an average of almost four years, according to a report released yesterday by the British journal the Lancet. The organs have remained free of the many complications that bedevil the conventional practice of surgically constructing bladders from other tissues.
If ongoing studies continue apace, the researchers said, they hope someday to offer patients more than a dozen other homegrown organs, including blood-vessel complexes, partial kidneys and perhaps hearts.
"It was really uncharted territory in terms of how you do these things," said Anthony Atala of Wake Forest University School of Medicine in Winston-Salem, N.C., who led the work with Alan Retik at Children's Hospital and Harvard Medical School in Boston. "We're very pleased with how well they're functioning."
Experts applauded the work as a coming of age for the long-struggling field of tissue engineering and as a possible way to bypass some of the controversy over embryonic stem cells.
Those versatile cells stir political trouble because obtaining them requires the destruction of human embryos. Although embryonic cells remain the most versatile biological building blocks, it now appears that at least some tissues, and even whole organs, can be generated without using the cells at all.
Should be interesting to see how this development continues and whether it can be used for other organs. [bm]