Thursday, July 24, 2008
The New York Times reports that Bill Gates and Mayor Michael R. Bloomberg have agreed to spend $500 million in an anti-smoking campaign to stop people around the world from smoking. Donald G. McNeil Jr. writes,
The World Health Organization estimates that tobacco will kill up to a billion people in the 21st century, 10 times as many as it killed in the 20th.
This time, most are expected to be in poor countries like Bangladesh and middle-income countries like Russia. In an effort to cut that number, Mr. Bloomberg’s foundation plans to commit $250 million over four years on top of a $125 million gift he announced two years ago. The Bill and Melinda Gates Foundation is allocating $125 million over five years.
CNN reports that genetic variations may predict patients who will get muscle pain and weakness as a side effect from taking cholesterol-lowering statin drugs. CNN writes,
In rare cases, statins can cause muscle pain and weakness. Researchers have identified a genetic variation that seems to predict more than half of these cases. People on statins who have the variant were about five to 17 times more likely to develop muscle problems, a serious side effect that can lead to muscle breakdown, kidney failure and death.
The finding raises hope that a test could be developed to screen heart patients to find out who is at greatest risk. Normally, muscle weakness caused by statins affects 1 out of 10,000 patients a year.
"It could become a very simple check," said Rory Collins of the University of Oxford, who co-authored the study published in Thursday's New England Journal of Medicine.
The New York Times reports that the FDA is urging doctors to use a genetic test to screen patients before prescribing the drug abacavir, which is widely used for HIV infections and AIDS. Andrew Pollack writes,
Seeking to prevent life-threatening side effects, the Food and Drug Administration is urging doctors to use a genetic test to screen patients before prescribing a drug widely used for H.I.V. infection and AIDS.
In an advisory it is expected to issue Thursday, the agency says that patients with a particular variation in an immune system gene should not be given the drug abacavir because they are at a far higher risk of a severe allergic reaction to the drug.
Abacavir, developed by GlaxoSmithKline, is sold under the name Ziagen. It is also a component of two combination pills — Trizivir and Epzicom.
The recommendation for the test is part of a movement toward so-called personalized medicine, in which genetic or other tests are used to determine which drugs are best for a patient and which should be avoided.
The labels of several other drugs, like the blood thinner warfarin and the cancer drug irinotecan, also recommend tests aimed at avoiding side effects or helping to adjust the dose.
CNN reports that although there are no published studies or definitive data, one cancer doctor is warning that cell phones are more than likely to cause cancer. CNN writes,
The warning from Dr. Ronald B. Herberman, director of the University of Pittsburgh Cancer Institute, is contrary to numerous studies that don't find a link between cancer and cell phone use, and a public lack of worry by the U.S. Food and Drug Administration.
Herberman is basing his alarm on early unpublished data. He says it takes too long to get answers from science, and he believes that people should take action now, especially when it comes to children.
"Really at the heart of my concern is that we shouldn't wait for a definitive study to come out but err on the side of being safe rather than sorry later," Herberman said.
The Los Angeles Times and The New York Times reports on the recent death of Victor McKusick, a doctor that linked specific diseases to specific genes, established one of the nation's first departments of medical genetics, and was one of the first to propose sequencing the human genome. Thomas H. Maugh II for the Los Angeles Times writes,
Dr. Victor A. McKusick, the Johns Hopkins University physician who is widely regarded as the father of medical genetics, died Tuesday at his home in Baltimore. He was 86 and died of complications from cancer.
McKusick was a pioneer in linking diseases to specific genes and began the first database of gene functions, a repository that now includes more than 18,000 human genes.
The two-week course in genetics taught by McKusick and his colleagues every summer in Bar Harbor, Maine, became the best-known and most respected course in the subject, bringing in more than 4,000 students, doctors and researchers from all over the country and introducing them to an entirely new way of addressing illnesses.
"Today we have lost a legend," said Dr. Edward D. Miller, dean of the Johns Hopkins medical faculty and chief executive of Johns Hopkins Medicine. "His influence and legacy reach around the world."
Wednesday, July 23, 2008
US News reports that Sen. Hillary Clinton and other advocates of women's rights say a planned regulation could cut access to contraception. Deborah Katz writes,
A new set of health laws that could be proposed by the government sometime in the next few weeks has women's health activists steaming. If the laws are implemented, they claim, women will have a harder time getting access to contraception.
The legislation, a draft of which was leaked last week to the New York Times, stokes the debate over when human life begins by taking the position that birth control that prevents the implantation of a fertilized egg actually results in abortion. It would prohibit federally funded medical facilities—including teaching hospitals and Planned Parenthood clinics—from refusing to hire doctors who don't want to dispense birth control pills and other types of contraception that may cause the expulsion of a fertilized egg. (It's already illegal to discriminate against doctors who refuse to perform abortions.) The new laws would also override state laws that require hospitals to offer emergency contraception to rape victims and those that require employers to provide contraceptives along with other prescriptions.
Late last week, Sen. Hillary Clinton called the planned rules (which could be imposed without congressional approval) "damaging" and a "dire threat to women" and warned that contraceptive coverage would "disappear overnight" if enacted. Dozens of organizations, including the American College of Obstetricians and Gynecologists and Planned Parenthood, have also voiced their objection, especially to the government's definition of the onset of pregnancy.
The New York Times reports on the tobacco legislation pending in Congress that will give the FDA regulatory authority over tobacco. Stephanie Saul writes,
In its sharpest criticism yet of the tobacco legislation pending in Congress, the Bush administration has said it “strongly” opposes the effort to give the Food and Drug Administration regulatory authority over tobacco.
The criticism came Monday in a letter by Michael O. Leavitt, the secretary of health and human services, which some saw as a signal that a veto would be likely if the legislation cleared the House and Senate.
The letter was sent to Joe L. Barton of Texas, the highest-ranking Republican member of the House Energy and Commerce Committee, which approved the bill in April. Mr. Barton voted against the bill.
The White House and the F.D.A. commissioner, Dr. Andrew C. von Eschenbach, have previously raised concerns about the legislation. The letter provided the strongest indication yet that the administration would try to block the bill.
The proposal has broad support in the House but, in the Senate, it is believed to be three votes short of a majority sufficient to override a veto. The House could vote on the measure as early as this month.
Writing for the New York Times, Kevin Sack questions whether Barack Obama's health plan can really lower health care costs enough to bring down premiums by $2,500 for the typical family. Sack writes,
It is one of the most audacious promises in a campaign that has been thick with them.
In speech after speech, Senator Barack Obama has vowed that he will lower the country’s health care costs enough to “bring down premiums by $2,500 for the typical family.” Moreover, Mr. Obama, the presumptive Democratic nominee, has promised that his health plan will be in place “by the end of my first term as president of the United States.”
Whether Mr. Obama can deliver is a matter of considerable dispute among health analysts and economists. While there is consensus that the American health care system is bloated with waste, eliminating enough to save $2,500 per family would require simultaneous and synergistic solutions to a host of problems that have proved intractable for decades.
Even if the next president and Congress can muster the political will, analysts question whether significant savings would materialize in as little as four years, or even in 10. But as Mr. Obama confronts an electorate that is deeply unsettled by escalating health costs, he is offering a precise “chicken in every pot” guarantee based on numbers that are largely unknowable. Furthermore, it is not completely clear what he is promising.
The Wall Street Journal continues coverage on the salmonella outbreak and reports on problems in the US food-safety system. Jane Zhang and Janet Adamy write,
The twisting road that led federal investigators to announce Monday that they found a single contaminated jalapeno pepper grown in Mexico and sitting at a distribution center in McAllen, Texas -- the smoking gun in the continuing salmonella outbreak long blamed on tomatoes -- has exposed problems in the U.S. food-safety system.
After weeks of trying to get to the bottom of the outbreak, it occurred to investigators in late June that they had to look beyond fresh tomatoes. In at least two large clusters of illnesses, tomatoes weren't a factor, and cases kept piling up after the government had warned consumers to avoid eating fresh tomatoes.
Hurdles to the probe ranged from poor record-keeping for tracking fresh produce to some overwhelmed state health departments to the fact that jalapenos had never before been implicated in a salmonella outbreak.
The Los Angeles Times reports on a study that finds viagra may be helpful to women whose sexual performance had flagged as a side effect of taking antidrepressants. Denise Gellene writes,
The long search for the female equivalent of Viagra has led researchers to . . . Viagra.
In a small study of 98 women published today, the little blue pill helped women whose sexual performance had flagged as a side effect of taking antidepressants, known as SSRIs -- a very specific finding that could open a new use for the male impotence drug.
The report in the Journal of the American Medical Assn. is one of the few to find some benefit for women despite nearly a decade of searching by its maker, Pfizer Inc.
More than 6 million women in the U.S. suffer from major depression. Antidepressants are the most common treatment for the mood disorder, and while they can be quite beneficial, they often have debilitating sexual side effects.
Doctors said the study, which was funded with a grant from Pfizer, could foster broader experimentation with Viagra for women, although they added that the drug was unlikely to become the blockbuster phenomenon it is among men. Its effectiveness in women is limited compared with men, and Pfizer has said it does not plan to develop the drug for female disorders.
Tuesday, July 22, 2008
The New York Times reports that the strain blamed for the salmonella outbreak shows up in a Mexican-grown pepper found in a Texas distribution plant. Officials warn against eating fresh jalapeños. Bina Venkataraman writes,
Federal food officials have matched a bacterial strain found on fresh jalapeños in a Texas distribution plant with the strain responsible for what has become the nation’s largest food-borne outbreak in the past decade.
The strain found on the jalapeños, Salmonella Saintpaul, was a genetic match to the strain found in lab tests of many of the 1,251 people who have become sick from salmonella poisoning over the past three months.
It was the first time officials had found the strain on fresh produce. But the discovery still does not tell investigators whether the contamination occurred in Mexico, where the peppers were grown, or at the distribution center in McAllen, Tex. The contamination might have also occurred somewhere in between, Dr. David Acheson of the Food and Drug Administration said Monday in a conference call with reporters.
The Los Angeles Times reports on a study of 203 pregnant women that finds a connection to an anti-epilepsy drug, topiramate, that raises the risk of birth defects. Experts caution that the group is too small to draw definitive results. Still, they say they aren't surprised. Thomas H. Maugh II writes,
A widely used anti-epilepsy drug called topiramate raises the risk of birth defects as much as 14-fold when taken by pregnant women, especially in combination with another drug called valproate, British researchers reported today.
Experts were quick to caution, however, that the study involved only 203 women, and thus significant statistical uncertainty remained about the research.
"You can't make any definitive statements from the data," said Dr. Kimford J. Meador of the University of Florida in Gainesville, who was not involved in the study.
But the results are not surprising, experts added, because topiramate -- sold by Johnson & Johnson under the brand name Topamax -- has been shown to cause similar defects in animals.
Writing for Time magazine, Lauran Neergaard suggests that investing $10 a year or leading a healthy lifestyle could cut health care costs by more than $16 billion annually. Neergaard writes,
Investing just $10 per person — roughly the price of a six-pack of beer and some chips — could greatly fuel community programs that get couch potatoes moving, prevent smoking and improve nutrition, researchers say.
How much health does $10 a person buy? Invest that every year, and within five years the nation could cut health care costs by more than $16 billion annually, concludes a new analysis by the nonprofit Trust for America's Health and a team of public-health research groups.
If the big dollars have your eyes glazing, the overall point is simple: Obesity — from poor nutrition and inactivity — and smoking are blamed for much of the heart disease, cancer, diabetes and lung diseases that are the nation's leading public health problems, fueling the $2 trillion annually spent on health care.
Yet small improvements can add up. Research suggests, for example, that walking 30 minutes a day and dropping just 15 pounds can cut in half the risk that someone with pre-diabetes will get the full-blown disease. The question is how to educate and persuade people to take such steps.
CNN gives a few tips about what patients should do in the process of going through sugery to avoid error and mistake. Elizabeth Cohen writes,
I thought my husband was crazy. When our 2-year-old daughter had hernia surgery, he insisted on seeing the surgeon minutes before to remind him that the hernia was on her right side, not her left.
The nurses weren't happy; it wasn't protocol to have the surgeon meet with parents immediately before a procedure.
"Maybe this is overkill," I said to my husband. "He knows what side the hernia's on. He's already seen her twice in his office. Plus, we've told the pre-op nurses 10 times it's on the right side."
But experts tell me my husband was right on. Mistakes do happen, no matter how great the surgeon, and it behooves you to help them get it right. Witness these headlines: Minnesota doctors remove the healthy kidney of a cancer patient while leaving the diseased one behind; California doctors remove the appendix of the wrong patient; one of the most experienced surgeons in a Boston, Massachusetts, hospital operates on the wrong side of a patient. All of these mistakes happened in the past year.
Solid numbers are hard to come by, because most states don't require doctors to report surgical errors. To make sure you're not the next victim, you might have to get pushy, like my husband did.
"You need to be that thorn in their side," said Dr. Samuel Seiden, an anesthesiologist who's co-author of a study on surgical errors. "You will catch things. You might also frustrate the nurses, but you have to look out for yourself."
Monday, July 21, 2008
The New York Times reports on a new experiment by federal and state government agencies as well as many insurers around the country that propose to cut health costs by paying doctors more. Milt Freudenheim writes,
Cutting health costs by paying doctors more?
That is the premise of experiments under way by federal and state government agencies and many insurers around the country. The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital.
Writing for the New York Times, Tyler Cowen suggests that cutting back payments to the relatively wealthy is a more efficient way to allocate government benefits. For health care costs, this could be done by expanding Medicaid and making it an entirely federal program, and also by limiting Medicare. Cowen writes,
Right now, the United States is in the midst of a financial crisis, but even more pressing problems may lie ahead — and the presidential candidates aren’t addressing them.
No matter who sits in the Oval Office next year, there won’t be many degrees of freedom in the federal budget. That’s because spending on entitlement programs is largely locked into place, and the situation will become much worse as Americans age and health care costs rise. Even if the government is conservative in its spending, just paying out promised benefits implies that tax rates will rise to a crushing level — a range of 60 to 80 percent of income — well before the end of this century.
The main problem is Medicare, which reimburses the elderly for many of their health care expenses. As Mark V. Pauly, professor of health care systems at the University of Pennsylvania, has said, “Medicare as we know it today cannot be sustained over the next 50 years and probably will run into financial difficulties within the next 15.”
Time magazine reports on a Canadian study finding that 90% of foods professed to be healthy for children did not meet established nutritional standards. Kathleen Kingsbury writes,
Most parents already know that sugary sodas and greasy potato chips are not the healthiest food choices for children. But what about the hundreds of other widely available and kid-friendly packaged foods — pastas, frozen dinners, granola bars — that at least appear to be more wholesome?
A new Canadian study suggests that even these foods — most of which make nutritional claims on their packaging — aren't all they profess to be. University of Calgary researchers analyzed the nutritional benefit of more than 360 such products, often marketed as "fun foods," which are aimed at children either through kid-friendly package graphics or tie-ins with children's TV shows and movies. Three-quarters of these foods, for example, came in packages bearing cartoon images. Researchers did not include junk food in their analysis, but they found that nearly 90% of kid products still did not meet established nutritional standards. What's more, 62% of the foods that researchers deemed to be of "poor nutritional quality" made positive nutritional claims on the package — such as being low-fat, containing essential nutrients or being a source of calcium. "If a parent sees a product that makes specific nutritional claims, they may assume that the whole product is nutritious," says author Charlene Elliott, a communications and culture professor at the University of Calgary. "Our study has shown that that is definitely not true in the vast majority of cases."
The Los Angeles Times reports on the toll the salmonella scare had on consumers and the agricultural industry with tomatoes: It cost the industry about $100 million and left people questioning the safety of foods. Ricardo Alonso-Zaldivar writes,
The tomato scare may be over, but it has taken a toll — it's cost the industry an estimated $100 million and left millions of people with a new wariness about the safety of everyday foods.
An Associated Press-Ipsos poll finds that nearly half of consumers have changed their eating and buying habits in the past six months because they're afraid they could get sick by eating contaminated food.
They also overwhelmingly support setting up a better system to trace produce in an outbreak back to the source, the poll found.
Sunday, July 20, 2008
The Washington Post reports that doctors in South Dakota must now tell women seeking an abortion that they will terminate a "unique living human being." The Court of Appeals for the 8th Circuit last week lifted a preliminary injunction that prevented the language from taking effect. Peter Slevin writes,
In a victory for antiabortion forces, doctors in South Dakota are now required to tell a woman seeking an abortion that the procedure "will terminate the life of a whole, separate, unique living human being."
The Chicago Tribune reports on how consumers will be affected regarding the recent cigarette tax increase in New York. Lisa Anderson writes,
If you think it's expensive to visit New York City, it's become even pricier to light up here.
The Big Apple now carries the nation's highest-priced cigarettes: $10 a pack, more than twice the nation's average price of $4.22. In Chicago it's about $7.50 a pack. But New York also boasts a lower proportion of adult smokers than the rest of the country — 17.5 percent compared with 19.7 percent nationally.
When it comes to smoking, apparently money talks. Dr. Thomas Frieden, the city's health commissioner, certainly thinks so. After a decade in which smoking prevalence stayed the same, the city's smoking rate dropped 21 percent among adults and 52 percent among public high school students in the five years following cigarette tax increases in 2002. Following last month's addition of a new state cigarette tax of $1.25 a pack, Frieden expects more of the city's 1 million smokers to quit.