Honestmed

2008-05-26T21:51:00.000-07:00

HonestMED Growth

2008-05-15T12:00:00.000-07:00

HonestMED has been quietly growing and expanding, especially in the last several months. Our Specialty Pages provide information and access to over 700 pages of medical information, and out Home page has been revised almost daily to provide current news and features. We invite readers to visit us often.

Pick the right hospital

2007-11-18T16:50:00.000-08:00

Picking the right hospital can save your life
Research hospitals in your area to find the best care for specific illnesses

The more a hospital performs a procedure, the better the results in most cases

Specialty training for hospital staff often can result in better patient outcomes

By Elizabeth Cohen
CNN

ATLANTA, Georgia (CNN) -- Chuck Toeniskoetter says he's alive today because of a nurse and a paramedic who came to his aid when he collapsed one snowy day high atop a mountain.

Studies are now finding that not all hospitals are created equal for every medical emergency.

They didn't administer CPR. They didn't give him life-saving drugs. They didn't treat him at all. What they did was get him to the right hospital.

The helicopter ambulance pilot wanted to take Toeniskoetter to the closest hospital. But the nurse and the paramedic suspected he'd had a stroke and urged the pilot to go to a certified stroke center, 15 minutes further away.

"They stood on the runners of the helicopter and were relentless with the pilot," Toeniskoetter remembers. "They saved my life."

At Sutter Roseville Medical Center in Roseville, California, Toeniskoetter received TPA, a drug that dissolved the clot in his brain. It's likely that at the other hospital -- the one the helicopter ambulance pilot wanted to take him to -- he wouldn't have received TPA.

Studies are now finding that not all hospitals are created equal for every medical emergency. Whether it's a stroke, a high-risk birth, or a heart attack, the research says it's worth doing whatever it takes to get to the right place. "A lot of people think hospitals are all the same," said Dr. Samantha Collier, chief medical officer at HealthGrades, which ranks hospitals. "They're not."

Consider this:

A new study in the Archives of Internal Medicine says heart attack patients have a higher chance of surviving if brought to one of U.S. News & World Report's Top 50 hospitals for treating heart problems.

A study earlier this year in the New England Journal of Medicine finds very low birth weight newborns are more likely to survive if treated in a high-level neonatal intensive care unit that takes care of a large volume of very low birth weight babies.

So how can you know which hospital is right for your medical needs?

Research hospitals on the Internet

"If we're going to spend hours on the Internet doing research before we buy a car, we should spend at least as much time researching hospitals," said Collier.

Her company's Web site, healthgrades.com, ranks hospitals by specialty, as does The Leapfrog Group. You can find out the best place to get hip surgery in Topeka, Kansas, or the best place to have a baby in New York City.

JointCommission.org lists hospitals that have certification for various medical specialties. Hospitalcompare.hhs.gov has detailed information about procedures performed at different hospitals.

Ask the right questions

Don't Miss
TIME.com: My patients are not customers, doctor says
If the information isn't available on the Internet, you'll have to call the hospital's quality office. Collier says ask about volume; hospitals that perform a high number of a given procedure -- heart bypass surgery, hip replacement -- usually have the best results, studies show. Leapfrog and HealthGrades have information about what constitutes high volume for various procedures.

Staffing also plays a key role. "Let's say I'm having a surgery where it's highly likely I'm going to have a stay in the intensive care unit," said Suzanne Delbanco, CEO of Leapfrog. "Your risk of dying in an ICU drops 40 percent if the doctors working there are 'intensivists,' which means they have specialty training in critical care. Ask if they have that kind of staffing."

What about an emergency?

It may sound strange, but it's possible to anticipate many emergencies.

Experts recommend thinking about what emergencies are most likely to happen in your family. Perhaps your mother has a heart condition, or perhaps you have a high-risk pregnancy and are at risk of having a premature baby.

Art Caplan, a bioethicist at the University of Pennsylvania, says the first step is to find out where an ambulance would take you if you dialed 911. If you want to go elsewhere, you might be out of luck. Often you can't persuade an ambulance driver to go to a stroke center if you've had a stroke, or to go to a children's hospital if your child is injured.

But you can be an informed consumer and check with emergency service providers in your area to find which hospital you'd be taken to and see whether you'd be able to negotiate a different destination.

After Chuck Toeniskoetter's experience, he started the Stroke Awareness Foundation, to help others choose the right hospital if they've had a stroke.

When he thinks about how the nurse and the paramedic argued for him to go the extra 15 minutes to the stroke center, he says he'll always be grateful.

"Those were the shortest 15 minutes of my life," he says.

Take Action Against Dangerous Drugs

2007-05-02T11:09:00.000-07:00

PennPIRG : Ask Congress to protect us from dangerous drugs

Our nation's drugs safety program is broken. In recent years the Food and Drug Administration (FDA) has been too cozy with the powerful prescription drug industry and approved dangerous and deadly medicines such as Vioxx, Paxil and Ketek. Vioxx is linked to heart disease, Paxil to suicide in children and Ketek to liver failure.

The good news is the Senate is considering drug safety legislation this week that will protect consumers from dangerous drugs like Vioxx and inform doctors of drug safety concerns.

Tell the bill's sponsors, Senators Ted Kennedy (D-Mass) and Mike Enzi (R-Wyo), that you support the bipartisan "Food and Drug Administration Revitalization Act" (S. 1082), and that they should oppose any amendments that will weaken the bill.

To take action, click on this link or paste it into your browser:
https://www.uspirg.org/action/health-care/petition?id4=ES

Then, ask your friends and family to help too by forwarding this e-mail to them.

Background

When Merck, the makers of Vioxx, first learned that their drug could cause serious health problems including heart attack and stroke, they could have told doctors and their patients. They didn't.

When GlaxoSmithKline, makers of the antidepressant Paxil, learned that it was linked to an increased risk of suicidal behavior in children, they could have sounded the alarm. They didn't.

These companies had the opportunity to do the right thing by giving doctors and patients the information they needed to make safe and informed medical decisions. They consciously chose not to tell the public the whole truth.

The problem is clear and there is bi-partisan agreement in Washington that something needs to be done. The pharmaceutical industry can't, and has proven that it won't, police itself. Lawmakers must reform the Food and Drug Administration so that it focuses on its original mission of ensuring that our medicines are safe.

The good news is that bi-partisan legislation, the "Food and Drug Administration Revitalization Act" (S. 1082) will reduce the number of consumers who die or suffer from adverse side effects cause by unsafe prescription drugs.

Tell the bill's sponsors, Senators Ted Kennedy (D-Mass) and Mike Enzi (R-Wyo), that you support the bipartisan "Food and Drug Administration Revitalization Act" (S. 1082), and that they should oppose any amendments that will weaken the bill.

To take action, click on this link or paste it into your browser:
https://www.uspirg.org/action/health-care/petition?id4=ES

Then, ask your friends and family to help too by forwarding this e-mail to them.

Sincerely,

James Browning
PennPIRG State Director
JBrowning@PennPIRG.org
http://www.PennPIRG.org

Gabcast Message for You

2007-05-01T16:21:00.000-07:00

Gabcast! HonestMED #1

CPR Update

2007-03-16T08:53:00.001-07:00

Chest presses, not breaths, help CPR

By MARILYNN MARCHIONE, AP Medical Writer 1 hour, 3 minutes ago

Chest compression not mouth-to-mouth resuscitation seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.

A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.

More than a year ago, the American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.

Another big advantage to dropping the rescue breaths: It could make bystanders more willing to provide CPR in the first place. Many are unwilling to do the mouth-to-mouth part and become flummoxed and fearful of getting the ratio right in an emergency.

Sudden cardiac arrest when the heart suddenly stops beating can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.

In the new study, researchers led by Dr Ken Nagao of Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who had cardiac arrest witnessed by bystanders. Of those, 439 received chest compressions only from bystanders, and 712 received conventional CPR compressions and breaths.

Any CPR attempt improved survival odds. However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR.

"Eliminating the need for mouth-to-mouth ventilation will dramatically increase the occurrence of bystander-initiated resuscitation efforts and will increase survival," Dr. Gordon Ewy, a cardiologist at the University of Arizona College of Medicine in Tucson, writes in an accompanying editorial.

A big caveat: The combination CPR in the Japanese study was given according to the old guidelines of 15 presses for every two breaths, not the 30 presses recommended now.

The American Heart Association said the study supports a focus on chest presses, but the association does not expect its advice to change. It recommends that bystanders provide compression-only CPR if they are "unwilling or unable" to do mouth-to-mouth breathing at the same time and for emergency dispatchers to give instructions on that.

The association wants to see survival results from programs that use compression-only CPR for cardiac arrest.

"It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions," a heart association statement says.

More than 300,000 Americans die from cardiac arrest each year. About 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.

Roughly 9 out of 10 cardiac arrest victims die before they get to the hospital partly because they don't get CPR.

Does God Say So?

2007-02-28T08:28:00.000-08:00

When God Sanctions Killing, The People Listen
28 Feb 2007

New research published in the March issue of Psychological Science may help elucidate the relationship between religious indoctrination and violence, a topic that has gained renewed notoriety in the wake of the September 11th terrorist attacks. In the article, University of Michigan psychologist Brad Bushman and his colleagues suggest that scriptural violence sanctioned by God can increase aggression, especially in believers.

The authors set out to examine this interaction by conducting experiments with undergraduates at two religiously contrasting universities: Brigham Young University where 99% of students report believing in God and the Bible and Vrije Universiteit in Amsterdam where just 50% report believing in God and 27% believe in the bible.

After reporting their religious affiliation and beliefs, the participants read a parable adapted from a relatively obscure passage in the King James Bible describing the brutal torture and murder of a woman, and her husband's subsequent revenge on her attackers. Half of the participants were told that the passage came from the Book of Judges in the Old Testament while the other half were told it was an ancient scroll discovered in an archaeological expedition.

In addition to the scriptural distinction, half of the participants from both the bible and the ancient scroll groups read an adjusted version that included the verse:

"The Lord commanded Israel to take arms against their brothers and chasten them before the LORD."

The participants were then placed in pairs and instructed to compete in a simple reaction task. The winner of the task would be able to "blast" his or her partner with noise up to 105 decibels, about the same volume as a fire alarm. The test measures aggression.

As expected, the Brigham Young students were more aggressive (i.e. louder) with their blasts if they had been told that the passage they had previously read was from the bible rather than a scroll. Likewise, participants were more aggressive if they had read the additional verse that depicts God sanctioning violence.

At the more secular Vrije Universiteit, the results were surprisingly similar. Although Vrije students were less likely to be influenced by the source of the material, they blasted more aggressively when the passage that they read included the sanctioning of the violence by God. This finding held true even for non-believers, though to a lesser extent.

The research sheds light on the possible origins of violent religious fundamentalism and falls in line with theories proposed by scholars of religious terrorism, who hypothesize that exposure to violent scriptures may induce extremists to engage in aggressive actions. "To the extent religious extremists engage in prolonged, selective reading of the scriptures, focusing on violent retribution toward unbelievers instead of the overall message of acceptance and understanding," writes Bushman "one might expect to see increased brutality"

Naps are Good

2007-02-12T09:06:00.001-08:00

Study: Napping might help heart

By LINDSEY TANNER, AP Medical Writer

New research on napping provides the perfect excuse for office slackers, finding that a little midday snooze seems to reduce risks for fatal heart problems, especially among men.

In the largest study to date on the health effects of napping, researchers tracked 23,681 healthy Greek adults for an average of about six years. Those who napped at least three times weekly for about half an hour had a 37 percent lower risk of dying from heart attacks or other heart problems than those who did not nap.

Most participants were in their 50s, and the strongest evidence was in working men, according to the study, which appears in Monday's issue of Archives of Internal Medicine.

The researchers said naps might benefit the heart by reducing stress, and jobs are a common source of stress.

It's likely that women reap similar benefits from napping, but not enough of them died during the study to be sure, said Dr. Dimitrios Trichopoulos, the study's senior author and a researcher at Harvard University and the University of Athens Medical School.

Heart problems killed 48 women who were studied, six of them working women, compared with 85 men, including 28 working men.

A daytime siesta has long been part of many cultures, especially those in warmer climates. Mediterranean-style eating habits featuring fruits, vegetables, beans and olive oil have been credited with contributing to relatively low rates of heart disease in those countries, but the researchers wanted to see if napping also plays a role.

"My advice is if you can (nap), do it. If you have a sofa in your office, if you can relax, do it," Trichopoulos said.

Exactly how stress is related to heart disease is uncertain. Some researchers think it might be directly involved, through unhealthy effects of stress hormones, or indirectly by causing people to exercise less, overeat or smoke.

The researchers in the latest study factored in diet, exercise, smoking and other habits that affect the heart but still found napping seemed to help.

Previous studies have had conflicting results. Some suggested napping might increase risk of death, but those mostly involved elderly people whose daytime sleepiness reflected poor health, Trichopoulos said.

His research team studied a broader range of people, ages 20 to 86, who were generally healthy when the study began.

Still, it's possible that study participants who napped "are just people who take better care of themselves," which could also benefit the heart, said Dr. Marvin Wooten, a sleep specialist at Columbia St. Mary's Hospital in Milwaukee.

"The guy ... who doesn't take time out for a siesta in their culture is probably the guy who is extremely driven and under a lot of pressure," which could increase heart risks, he said.

Siestas aren't ingrained in U.S. culture, and napping usually is equated with laziness in the high-charging corporate world, said Bill Anthony, a Boston University psychologist and co-author of "The Art of Napping at Work."

Still, some offices allow on-the-job naps, and many workers say it makes them more, not less, productive.

Yarde Metals, a metals distributing firm, built a nap room at its Southington, Conn., headquarters as part of an employee wellness program. With two leather sofas, fluffy pillows, soft lighting and an alarm clock, it's the perfect place for a quick snooze, engineer Mark Ekenbarger said.

Ekenbarger, 56, has an enlarged heart artery and said he frequently takes half-hour naps on the advice of his doctor to reduce stress.

"It really does energize me for the rest of the day," Ekenbarger said.

"It would be really encouraging if employers across the country really embraced that philosophy that napping is a good thing. It makes a big difference in my life."

Pennsyvania Prescriptions

2007-01-29T13:41:00.000-08:00

Prescription for competition

By Rick StoufferTRIBUNE-REVIEW (PITTSBURGH)
Tuesday, November 28, 2006

Pharmaceutical shoppers hoping to save money now can find $4 generic prescriptions at three major chain stores, but consumers should compare costs if they have health insurance and should not expect other pharmacies to follow suit. Giant Eagle Inc., Wal-Mart Stores Inc. and Target Corp. have brought to Pennsylvania programs offering some of the most popular pharmaceuticals at $4. Some hail the programs as good deals for consumers, but a trade group representing independent pharmacies warned that the plans might not offer real savings.
The programs at Giant Eagle, Wal-Mart and Target offer similar drugs and dosages, making available more than 310 total prescriptions. All offer up to 30-day supplies.
When looking for the best price, shoppers with health insurance plans that include drug coverage should compare what it costs to get medicine by simply paying a co-pay, which varies depending on the price worked out between the insurer and pharmacy.
But in general, consumers without insurance now can get many drugs at low cost, said Monica Skomo, assistant professor at Duquesne University's Mylan School of Pharmacy.
"These programs are going to have a major impact," she said. "There are several of the most widely prescribed medications on the lists and that will benefit a number of people, particularly those with lower incomes."
The cost to fill a generic prescription is more than $4, Skomo said. That means Giant Eagle, Wal-Mart and Target might be looking at the inexpensive prescriptions as loss leaders to bring in non-$4 prescriptions.
Giant Eagle has 93 in-store pharmacies statewide, and Wal-Mart has 131. The number of Target pharmacies in Pennsylvania wasn't immediately known.
Patricia A. Epple, executive director of the 2,000-member Pennsylvania Pharmacists Association, a trade group of independent pharmacies, said the programs might not have much impact.
"It's more like a bait-and-switch deal," she said. "The program sounds really good, but when you get to the counter with your prescriptions, you find it applies to a lot of older medications and the offerings are multiple dosages for the same medication."
Epple said between 58 percent and 68 percent of all prescriptions filled at independent pharmacies are generic.
Some competitors said they won't offer a $4 generic plan.
"We have no plans to offer such a program. We feel our close proximity to customers with our many locations outweighs saving a few pennies on prescriptions," said Rite Aid spokesman Jody Cook. Rite Aid has 92 pharmacies in the Pittsburgh area.
Wal-Mart initiated the $4 generic price in late September, starting in Florida. Beginning today, all 3,810 pharmacies in the 49 states where the Bentonville, Ark.-based giant operates its own pharmacies will offer the $4 plan.
The programs vary. Giant Eagle, for example, offers more anti-anxiety, anti-fungal and arthritis-related generics than Wal-Mart, while Wal-Mart makes available cholesterol, gingivitis, incontinence and oncology/cancer generics not offered by Giant Eagle.
"We see these $4 generic prescriptions as very helpful," said Barney Oursler, director of the Mon Valley Unemployed Committee. "A lot of people assume they can't afford drug prices. Now they have the assurance going in that they will pay $4."

Folic Acid is Key

2007-01-19T14:25:00.000-08:00

Folic Acid Increases Mental Agility In The Elderly
19 Jan 2007

Taking supplements of folic acid may significantly improve cognitive function in older men and women.

This is the conclusion of a Dutch study to be published in the Lancet.

The study was led by Jane Durga from the Wageningen University in The Netherlands.

Diminshing cognitive functions such as deterioration in memory, reduced ability to process information quickly, and reduced verbal fluency have been linked to risk of dementia in old age.

Dr Durga and colleagues followed a group of 818 over-50s for three years. Some were given 800 micrograms of a synthetic form of folic acid per day, the rest took a placebo. A synthetic version of the vitamin was used because the naturally occurring form degrades more easily, for example with storage and cooking, and that would make any results less reliable.

The scientists found that the group who took the folic acid improved on all aspects of cognitive functioning compared to the group that took the placebo.

Folic acid is a water soluble B vitamin and is found in yeast extract, green leafy vegetables, for example spinach, in dried beans and peas, some organ meats such as liver, fortified cereals, certain fruit and vegetables, and certain seeds, for example sunflower seeds. It plays an important role in the production of new cells, especially in the spinal cord an embryo, which is why it is important that pregnant women have their reference daily intake (RDI).

Adults and children need folic acid to generate red blood cells and DNA, and insufficient daily intake can result in anemia. The vitamin also helps to digest protein and make effective use of the resulting amino acids, and also to produce proteins that the body may be lacking. It also plays a role in regulating appetite.

Because of the discovery of the link between neural tube defects (NTD, such as that occurring in infants born with spina bifida), and insufficient folic acid governments have gradually introduced regulations that require certain foods to be fortified with folic acid, such as cereals, and in some countries bread and flour also.

Different countries recommend different RDI amounts, ranging from 400 micrograms a day in the US to 200 in Japan.

Some research studies have linked folic acid supplement taking with reductions in various age-related impairments such as hearing loss and Alzheimer's. Others are not so clear, but there seems to be consensus that it helps improve cognitive function in elderly people with high concentrations of the amino acid homocysteine in their blood, which could indicate increased riks of stroke, heart disease and Alzheimer's.

Concerns have been raised that folic acid interacts with Vitamin B12 and taking too much of it can cause problems, such as masking a deficiency in B12. This is particularly relevant to older people (over 50), who should ask their doctor to check their vitamin B12 levels if they considering taking folic acid supplements.

Staph

2007-01-19T11:31:00.000-08:00

Staph bug causes new pneumonia
By Maggie Fox, Health and Science Editor Thu Jan 18, 5:43 PM ET

WASHINGTON (Reuters) - A nasty staph germ circulating in and out of hospitals produces a poison that can kill pneumonia patients within 72 hours, researchers said on Thursday.
Staphylococcus aureus bacteria -- or S. aureus -- can pass one another the gene for the toxin and are apparently swapping it more often, the researchers report in Friday's issue of the journal Science.
The toxin, called Panton Valentine leukocidin or PVL, can itself cause pneumonia and can kill healthy tissue.
Luckily, people infected with the bacteria quickly develop a high fever and astute doctors can identify it, said Gabriela Bowden of the Texas A&M Health Science Center in Houston, who led the study.
"This is a scary situation. We are trying to put the word out and to educate people about it," Bowden said in a telephone interview.
S. aureus is the most common cause of hospital-acquired infections, and can cause inflammation of the heart, toxic-shock syndrome and meningitis.
A new strain called MRSA resists the antibiotic methicillin, but it can be treated with antibiotics like doxycycline and vancomycin.
An outbreak of methicillin-resistant S. aureus carrying the new toxin killed two patients in a British hospital in December with a new type of pneumonia called necrotizing pneumonia. This infection destroys lung tissue and also kills some of the immune system cells sent to battle it.
Dr. Marina Morgan, consultant medical microbiologist at Exeter Nuffield Hospital in Britain, said the PVL toxin "turbo-charges" an already dangerous bacteria.
"PVL is strong enough on its own to destroy the lungs," she said in a statement.
And the toxin is immune to antibiotics.
"The reason most patients die is that despite killing the bug, PVL toxins already formed continue to digest lung tissue, so we desperately need some way of removing the toxins," Morgan said.
S. aureus, which commonly live on the skin and cause pimples, boils and other minor infections, can cause a serious wound if the toxin-producing strains get into a cut.
WASH THOSE HANDS
Old-fashioned hygiene is the best line of defense, Bowden said.
"This is a community-associated strain, which means that in schools, the kids can carry it. Anybody can be colonized with it," she said.
"I tell my kids if you scrape your knee, go to the bathroom immediately and wash it with soap." Hospitals must impose strict hygiene to control it.
Bowden's team tested the PVL-producing Staph on mice and found that two days after infection, their lungs were filled with immune cells and lung tissue was starting to bleed and die. A stretch of DNA known as a cassette carries the code for the PVL toxin. Such a little segment is easily passed from one strain of bacteria to another, said Bowden, and viruses called bacteriophages can also carry them. Understanding how this happens could provide a way to develop new drugs or vaccines and shed light on how bacteria acquire new and dangerous qualities. "The appearance of PVL toxin in severe Staphylococcal pneumonia is a recent phenomenon. Previously the toxin was only found in less than 5 percent of strains," said Dr. Ronald Cutler of the University of East London. Some companies are working on staph vaccines but none is on the market.

It's Obvious, but...

2007-01-19T01:35:00.000-08:00

Back to Story - Help

Texas study suggests link between pollution, cancer

Thu Jan 18, 11:50 PM ET

A University of Texas study found a possible link between childhood leukemia and living close to the city's refinery row along the Houston Ship Channel, one of the study's co-authors said on Thursday.

The study found that living within two miles of elevated levels of 1,3-butadiene around the ship channel's petrochemical complex was associated with a 56 percent increased incidence of childhood acute lymphocytic leukemia compared with those living more than 10 miles away, according to a statement from the city of Houston, which financed the study.

"When we looked at distance from the ship channel we find data that suggests there is an association with chemicals in the air and childhood leukemia," said Ann Coker, professor of epidemiology at the University of Texas School of Public Health in Houston.

Houston Mayor Bill White said the city would use the study to support efforts to reduce pollution from petrochemical plants.

"The science supports our claim that reducing hazardous air pollutants must be a high priority for Houston," White said in a statement.

White has used the threat of tougher enforcement of anti-pollution laws to win agreements from petrochemical plants to reduce pollution.

The substance 1,3-butadiene is used to make petrochemicals like ethylene.

Alternative Medicine?

2007-01-17T10:08:00.000-08:00

Alternative Medicine

Alternative medicine is one of the latest of many trends, but one thats going to stick around longer than the others. People are getting back to basics, no matter what lifestyle, age bracket or income level they achieve. Doctors are finally taking into consideration the fact that the public likes to treat themselves and they like the idea of taking natural medicines, and the need is there for education on how to treat the masses who are also treating themselves at home. But, even if theyre educated about alternative medicines, the doctors still cant read your minds,. You must tell them what youre taking and its important.

Herbal remedies do what theyre touted to and sometimes that saves us a trip to the doctors office. Because theyre herbal and you can buy them alongside vitamins at the grocer, people regard the remedies as safe and they dont do a lot of research before buying and trying them. One woman was known to give her toddler Kava Kava tea in her bottle (this is NOT recommended), further showing the general publics trust in the safety of an herbal over the counter product.

The truth is, herbal remedies are medicine just like the synthetic ones are, and thats why we should tell our doctors when were taking them during any kind of treatment. Drugs mix in your body, herbal and prescription.

For example, you might be suffering from minor depression or undergoing heavby stress, and someone with good intentions might offer you some St. Johns Wort tea or capsules. Its herbal, inexpensive and it helps, so people dont mind sharing, and people dont mind taking something thats natural. Later, you go to the store and bu your own bottle and begin taking them. But, neither you nor the person that first gave you the remedy realizes the calming effects of the herb are weakening the strength of their birth control pills.

Just like all synthetic drugs, herbal remedies interact with many prescription drugs and change or cause side effects. They can also cause the efficacy of prescription drugs to increase or decrease, making them potentially dangerous even when taken as prescribed.

For example, we take garlic for all kinds of things, from ridding our home and pets of fleas to gaining stronger immune systems, and we can take it in so many delicious ways. Its very popular, affordable, and it works. Garlic isnt just an herbal remedy, but, is considered a food, too. So, if we take garlic supplements and use it in our diet as well, we could be getting a hefty dose of it every day, which isnt harmful. But, do you know what drugs it can interact with? You wont find it on the drug packaging and if your doctor doesnt know youre taking garlic supplements, he wont know to tell you.

Garlic reduces the efficacy of:

T abAntihypertensives: dittiazam (cardizem), nicarpedine (cardene) and verapamile (calan)

T abHIV protease-inhibitors: saquinavir (fortovase, invirase)

T abImmunosuppressants: cyclosporine (sandimmune)

T abOral contraceptives

Garlic increases the efficacy of:

T abDiabetes drigs such as: chlorpropamide (diabinese), insulin, glipizide (glucotrol), rosaglitazone (Avandia)

T abVarious blood thinners are dangerously increased in side effects

And that St. Johns Wort youve been taking, do you know what drugs it has an interaction with? Its worth asking your doctor or looking up the information. It not only can decrease the efficacy of your birth control pills, but it can also increase the efficacy of MAO inhibitors and antidepressants. Say you took garlic supplements and eat a lot of it in your cooking, too, and then you take St. Johns Wort tea daily. Your birth control protection could be just about nil.

Some people say the only difference between a poison and a medicine is the dose. Now, we should modify that statement to the dose and/or mixture.

The side effects of a prescription medicine can also be increased or decreased in severity, and new ones may spring up bedcause of the mixture of medicines, as well. If your doctor knows youre taking an herbal supplement, he may advise you to stop taking it during treatment with certain prescriptions. It may be dangerous not to tell him, as you can see.

T abAn her popularly taken as a mild antibiotic for the mucous membranes in the head and chest, Echinacea, increases the blood thinning ability of the drug Coumadin, also known as Warfarin.

T abHeal-all (also called self-heal or prunella vulgaris), a little purple flower that grows in grass is a great tonic and good tasting tea, hot or cold. It has the ability to actually thin blood and not only should it be avoided while taking blood thinners like Coumadin, it also cannot be taken a week before any type of surgery is performed or the patient could endure bleeding problems during the procedure.

T abColtsfoot is a common age-old remedy for coughs, among other things, and has always been considered so safe that its good for children to take it. However, if youre taking an antihypertensive prescribed by a doctor, a dose of Coltsfoot could send a hypertensive child to the other end of the psectrum, leaving them hypotensive (the opposite).

Its just a good idea to let your doctor know everything you take, even if its an over the counter remedy you got at the corner market.

SOURCES:

All of the information in this article is from experience and these three sources:

Professionals Handbook of Complementary & Alternative Medicines, by Charles W. Fetrow, PhD and Juan R. Avila, PhD. Springhouse Publishing

Growth Hormone

2007-01-16T14:23:00.000-08:00

Growth Hormone Doesn't Help You Live Longer

16 Jan 2007

A new study has indicated that not only does growth hormone not help you live longer, but it comes with a substantial potential for adverse side effects, such as diabetes, carpel tunnel syndrome and swollen joints. Growth hormones have been promoted for years as wonder products that can prevent, even reverse, the aging process.

You can read about this study in the Annals of Internal Medicine.

Researchers from the University of Stanford looked at 31 studies. In all the studies growth hormone had been used on elderly patients. The patients were slightly overweight, but none had any serious health problems at the beginning of each study. The researchers found that growth hormones did bring about a slight reduction in body weight and a slight increase in muscle. They did not detect, however, any change in the patients' cholesterol levels, aerobic capacity or bone density.

The researchers did find that there was an increase in developing soft tissue edema (swelling), arthralgias, carpal tunnel syndrome and gynecomastia. They were also more likely to experience the onset of diabetes mellitus and impaired fasting glucose.

Dr Hau Liu, team leader, said "There is certainly no data out there to suggest that giving growth hormone to an otherwise healthy person will make him or her live longer. We did find, however, that there was substantial potential for adverse side effects. In short, the studies provided no real evidence that the therapy resulted in increased fitness."

The study looked at t total of 220 participants who received growth hormone (GH). Their average age was 69.

We all produce GH in the pituitary gland. Production peaks during our childhood years and wears off in our thirties.

"Systematic Review: The Safety and Efficacy of Growth Hormone in the Healthy Elderly"
right arrow Hau Liu, MD, MBA, MPH; Dena M. Bravata, MD, MS; Ingram Olkin, PhD; Smita Nayak, MD; Brian Roberts, MD; Alan M. Garber, MD, PhD; and Andrew R. Hoffman, MD
Annals of Internal Medicine
16 January 2007 | Volume 146 Issue 2 | Pages 104-115
Click here to see the review online

Written by: Christian Nordqvist
Editor: Medical News Today

Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=60914

Avoid liver cancer

2007-01-03T13:08:00.000-08:00

Diet seen to affect liver cancer risk: study

Certain foods, including milk and fruit, appear to reduce the likelihood of developing liver cancer, according to Italian researchers.

Their study, Dr. Renato Talamini told Reuters Health, "indicated that diet has a relevant role in the risk of this cancer. As for other types of cancer, particularly fruits and vegetables seem to confer a protective effect."

Talamini, at the National Tumor Institute in Aviano, and colleagues studied 185 patients with liver cancer and a comparison group of 412 "controls" without cancer. The results are reported in the International Journal of Cancer.

The participants' responses to dietary questionnaires showed that as intake of various foods went up, the risk of liver cancer went down. After accounting for other factors that could affect the risk, the team found that high intakes of milk and yoghurt reduced the chances of developing liver cancer by 78 percent.

High consumption of white meat lowered the risk by 56 percent, and with high intake of fruit, it went down by 52 percent. Vegetables, too, apparently had a protective effect, but this didn't reach significance from a statistical standpoint.

The researchers saw that the findings held good for patients with hepatitis B and hepatitis C virus (HCV) infection.

Talamini advised that, to ward off liver cancer, one should "adopt a correct diet, rich in fruits and vegetables." Also important, he added, "is limiting consumption of alcohol beverages and avoiding HCV infection by practicing safe sex and eliminating needle sharing."

Drug Cost Rarely Discussed

2006-11-10T02:57:00.000-08:00

Doctors Rarely Discuss Drug Costs With Patients

Wed Nov 8, 7:04 PM ET

WEDNESDAY, Nov. 8 (HealthDay News) -- U.S. doctors often fail to discuss costs, prescription drug insurance coverage and other related issues when they give new prescriptions to patients, a new study finds.

These are all important issues because they're linked to whether patients will continue taking their medications, the researchers note.

"Though cost discussions are not always necessary, especially if physicians know a patient's financial situation and the best formulary choice for a medication, physicians must have a high level of awareness about medication cost and issues impeding acquisition to medication, because these can be important barriers to patient medication adherence," lead author Dr. Derjung Tarn, assistant professor of family medicine at the University of California, Los Angeles, David Geffen School of Medicine, said in a prepared statement.

His team's published their findings in the November issue of the American Journal of Managed Care.

The study included 185 patients who had outpatient visits with 15 family doctors, 18 internists and 11 cardiologists. In total, about 243 new medications were prescribed during these visits.

In only 33 percent of the cases did the doctors talk with patients about issues related to medication cost, insurance, generic or name-brand, logistics, supply and refills. Cost and insurance were addressed 12 percent of the time, the logistics of obtaining medications 18 percent of the time, and medication supply 9 percent of the time.

Patients initiated discussions about medication costs or insurance in only 2 percent of the cases.

The study found that discussions about drug costs were more likely to occur if a patient earned less than $20,000 per year than if they earned more than $60,000 a year.

Family doctors and internists were less likely than cardiologists to talk with patients about costs, and all doctors were less likely to do so when prescribing medications to older patients, the study said.

More information

The American Academy of Family Physicians has more about prescriptions and insurance plans.

Making Surgery Bloodless

2006-11-09T20:48:00.000-08:00

Transfusions not needed in bloodless surgeries
MAKING SURGERY BLOODLESS / FIRST OF TWO PARTS
Sunday, May 07, 2006

By Mark Roth, Pittsburgh Post Gazette

--------------------------------------------------------------------------------

In Pittsburgh and across the nation, surgeons are doing as many operations as possible without using a drop of donated blood.

The approach, sometimes known as bloodless surgery, emphasizes techniques that boost red blood cell counts before and after an operation, and cut blood loss while it is going on.

According to doctors at Allegheny General Hospital's Center for Bloodless Medicine and Surgery, the techniques free up blood for use in true emergencies, such as major car accidents, at a time when it remains difficult to get people to donate blood. About 8 million Americans donate blood each year -- 5 percent of those eligible.

It also saves money.

Dr. Jan Seski, a cancer surgeon who has pioneered bloodless surgery methods in Pittsburgh, said there was no doubt how important blood transfusions can be in some cases.

"Blood products are as safe as they've ever been," he said, "and we use them when we need to. Let's not minimize the necessity of blood in certain circumstances."

In many operations, however, there are ways to avoid transfusions, and doing so can not only make doctors better surgeons, but it also can cut infections, complications and healing time.

"Not all surgeons can do this because not all surgeons can do surgery without losing an excessive amount of blood," said Dr. Seski, chief of gynecologic oncology at Allegheny General. "It's just like anything else in life. There are certain degrees of expertise."

Studies have shown that patients who get transfusions have more infections and complications after surgery, Dr. Seski said. Those who undergo cancer surgery have more recurrences if they get transfusions, he added.

Even when it is matched properly by blood type, donated blood "just overwhelms the immune system and plugs it up for a while, so the body has trouble recognizing foreign invaders," Dr. Seski said.

"If we could do surgery without using blood," Allegheny General heart surgeon George Magovern Jr. said, "that would probably be best."

The savings accompanying bloodless surgery are not just in buying less blood.

"The savings to hospitals that have employed a comprehensive program of reducing blood transfusions is, like, $3 million to $4 million a year," Dr. Seski said. "It's saving on the cost of nursing time, the cost of blood, the reduction in infections, side effects and complications."

Dr. Seth Perelman, associate chief of anesthesiology at the nation's leading bloodless surgery center, Englewood, N.J., Hospital Medical Center, said many hospitals use blood transfusions in up to half their surgeries.

In his hospital, it's down to 15 percent.

Dr. Jonathan Waters, chief of anesthesiology at Magee-Womens Hospital and head of UPMC's surgical blood management program, said it was difficult to know how much the growing number of blood-saving programs is reducing demand for transfusions around the country.

It is harder to cut down on blood use in a large multihospital health system such as UPMC's than at community hospitals such as Englewood, he said.

Nevertheless, Dr. Waters said, blood conservation programs can have a big impact. When he helped found the Cleveland Clinic's blood management program nine years ago, it saved the hospital 10,000 units of blood in its first year.

Right now, he said, UPMC is working to eliminate the practice of having patients donate their own blood ahead of time for use during surgery, and instead use machines to salvage their blood during the operations. It also is trying to get its major hospitals accredited in blood management by the American Association of Blood Banks.

Many of today's bloodless surgery techniques were developed because of the strong beliefs of a religious sect that has its roots in Pittsburgh.

The Jehovah's Witnesses, founded in Pittsburgh in 1872 by Charles Taze Russell, rely on verses from Leviticus, Deuteronomy and Acts as the basis for their refusal to accept blood transfusions.

They interpret the Bible to mean that they can't donate their own blood ahead of time because it would be completely separated from their bodies.

Like many other surgeons involved in bloodless medicine, Dr. Seski got his start treating Jehovah's Witnesses.

After years of experience with them, he feels their refusal to accept transfusions should be viewed as any other medical complication.

"If a patient comes into my office and she weighs 400 pounds and I have to do an operation on her," he said, "I don't say go and lose the weight before I take your cancer out. I have to operate on this person, despite her complications.

"The same thing is true of diabetes, hypertension, severe heart disease. ... All of these things complicate a surgical procedure. If the patient comes in and says I don't want blood, that's just another hurdle we have to get over to cure this patient of cancer."

Allegheny General, UPMC and other sites use five primary methods to avoid or limit blood transfusions:

Hormones. Doctors use synthetic versions of the hormone erythropoietin, which manufactures oxygen-carrying red blood cells in the bone marrow, to build up patients' hemoglobin counts before and after surgery.

The hormones ensure patients won't be anemic going into surgery, and help rebuild their red blood cell counts afterward in four to six weeks, instead of the three to four months it used to take, Dr. Seski said.

Hemodilution. In many surgeries, doctors will remove one to two pints of blood from a patient before surgery begins and route it through a machine that separates it into red blood cells and clear plasma.

They put the plasma and clear saline solution back into the patient so that his blood volume remains the same. Because red blood cells have been removed, however, any blood lost during surgery will have far less hemoglobin in it than normal.

They also can suction some of that blood and put it through the same filtering machine, and then, when the surgery is done, they can put the red blood cells back into the patient.

Cautery. Surgeons use electric and argon laser beam scalpels to seal off blood vessels as they operate, slowing blood loss. Surgical clamps which can cut off the blood supply to operative areas are also important.

Microsampling. Instead of drawing vials of blood during surgery and sending them to a lab, surgeons can now use machines that analyze a single drop of blood inside the operating room to check on its clotting and oxygen-carrying ability.

That not only saves time, but also lets doctors know more precisely whether the patient needs plasma for clotting or red blood cells.

Pediatric blood tubes. One of the stealthiest ways patients lose blood in the hospital is when their blood is drawn for testing after surgery.

If a patient goes into the intensive care unit, Dr. Seski said, standard blood testing could cost a pint of blood every week. By using diminutive pediatric blood tubes, though, hospitals still can do their tests and reduce much of that blood loss, he said.

There is no better proof of the value of these techniques than Wade Moss, of Murrysville.

Mr. Moss, 46, a former custodian in the Gateway School District, had major colorectal surgery in early 2002, had a hip replacement later that year and had his other hip replaced in 2004, all without receiving transfusions.

Mr. Moss, now on disability, is actively involved in Jehovah's Witnesses ministry and never had the slightest doubt about refusing transfusions.

"People think blood is a lifesaving fluid that's going to make you feel better," Mr. Moss said. "But in reality, it's the [blood] volume you're losing that hurts you more than anything.

"Not taking blood, from a lot of doctors' perspective, is actually safer and it helps the doctor become a better surgeon. If a doctor needs a lot of pints of blood, it could mean he's being sloppy. And we, as Jehovah's Witnesses, have raised that awareness."

Many of the hospitals that pioneered bloodless surgery techniques were smaller centers that wanted to attract Jehovah's Witnesses, UPMC's Dr. Waters said.

But now, major institutions such as the Cleveland Clinic, the Mayo Clinic, Johns Hopkins and UPMC are jumping on the bandwagon, he said.

One example of the growing interest in the discipline, he said, is that the Web site for the Society for the Advancement of Blood Management has grown from 4,000 to 13,000 unique visitors in recent months,

Bloodless surgery also fits well with other medical trends, Dr. Seski said.

More and more doctors are doing minimally invasive surgery which uses small incisions and tubes and scopes to perform operations, he said, and research is moving forward on artificial hemoglobin products that might reduce the need for blood donations even further.

These advances will become all the more important when baby boomers hit retirement and sharply increase the expected number of surgeries and cancer treatments.

But for any given surgery, transfusions are likely to decrease in the future, Dr. Seski said.

"I think we're going to be using less blood 10 years from now than we're even using now," he said.

From the Surgeon General...

2006-10-27T22:23:00.000-07:00

Surgeon General Urges Public To Play Role In Reducing Health Disparities

27 Oct 2006

If we had eliminated ethnic disparities in health in the last century, there would have been 83,500 fewer deaths of African Americans in the year 2000 alone, says David Satcher, the 16th US Surgeon General, in a compelling essay in PLoS Medicine.

"In seeking solutions to the problem of ethnic disparities," he says, "we all must be proactive as advocates for change." Dr Satcher outlines his vision for how everyone can play a crucial role in reducing disparities by, among other things, advocating for universal access to health care, ensuring greater representation of minority populations in the health professions, creating non-violent and exercise friendly neighborhoods, and supporting research on why health disparities persist.

"We all have roles to play in the elimination of ethnic disparities in health," says Dr Satcher. "We must all care enough; we must know enough; we must do enough; and we must persist in our efforts until health disparities are eliminated in this country."

Citation: Satcher D (2006) Ethnic disparities in health: The public's role in working for equality. PLoS Med 3(10): e405.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030405

CONTACT:

David Satcher
Morehouse School of Medicine
720 Westview Drive SW
Atlanta, GA 30310 United States of America

###

Social medicine in the 21st century

Contact: Andrew Hyde
Public Library of Science

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=54991

Flu Shots

2006-10-24T14:45:00.000-07:00

Study finds flu shots are safe for kids

By CARLA K. JOHNSON, Associated Press Writer 53 minutes ago

The biggest study ever to look at the side effects of flu shots in children confirmed that the vaccine is safe for babies and toddlers.

Researchers studied 45,000 U.S. children and found almost no side effects requiring medical treatment during the six weeks after the youngsters were vaccinated.

The Centers for Disease Control and Prevention estimates that more than 90 children under 5 die of the flu each season.

Flu vaccine has a good safety record, the researchers wrote, though some formulations have been linked to Guillain-Barre syndrome, a rare paralyzing disorder.

With the shots now recommended for all children younger than 5, the findings are reassuring, said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University who was not involved in the study.

"Linus had a security blanket, and this is a huge security blanket," Schaffner said. "This is a comfort to all providers, parents and policymakers that we can move ahead with great, great confidence."

Researchers found a few more cases of mild nausea and diarrhea than expected within the first two weeks after the shot, but the numbers were extremely low considering the thousands of children studied: 13 cases.

After their flu shots, the children were less likely to get treated for upper respiratory tract and ear infections. That could have been because parents felt reassured that the symptoms were not signs of flu, said study co-author Dr. Simon Hambidge, an investigator at Kaiser Permanente Colorado's clinical research unit.

The federally funded study appears in Wednesday's Journal of the American Medical Association.

"This is really reassuring for parents and for doctors who want to protect children from what's a pretty nasty disease," Hambidge said. "We know children in this age group get hospitalized for complications of influenza as much as elderly adults do."

Nine of the study's 19 co-authors reported financial ties to vaccine manufacturers, but the industry had no direct role in the study.

___

Competition Reduces Costs

2006-10-23T18:37:00.000-07:00

Competition In Health Care Industry Can Help Reduce Costs, Opinion Piece Says

23 Oct 2006

"Choice and competition work in health care," but "most of us aren't lucky enough to have access to a market shaped by them," Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation, writes in a Washington Times opinion piece. For example, under the "consumer-driven" Federal Employees Health Benefits Program, members can select from 284 private health plans nationwide, and their premiums on average will increase by only 1.8% this year, Moffit writes. In addition, under the Medicare prescription drug benefit, beneficiaries can select from a number of private health plans to provide coverage, and "intense competition among plans" has reduced medication costs for beneficiaries, he writes. However, most U.S. residents "have never been near a competitive health care system" because employers in most cases offer few health plans or only one plan, according to Moffit. In response, he writes, some lawmakers have "come up with innovative ideas to introduce competition into the health care system." Sens. Mel Martinez (R-Fla.) and Tom Coburn (R-Okla.) have introduced the Tax Equity and Affordability Act, which would provide tax credits to help individuals and families purchase health insurance, Moffit writes, adding that the tax credits "would enable them to buy the health plans of their choice." In addition, Sen. Jim DeMint (R-S.C.) and Rep. John Shadegg (R-Ariz.) have introduced the Health Care Choice Act, which would allow U.S. residents to purchase health insurance in any state, regardless of their place of residence, to establish a "national market," Moffit writes. "Again, today, only federal workers and retirees have anything like a national market for health insurance," he writes, adding, "After the November elections, perhaps Congress will get serious and put the common good of millions of Americans over the special interest of a few who fear a genuine free market in health care" (Moffit, Washington Times, 10/19).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=54615

Good Mothers

2006-10-23T12:43:00.000-07:00

Women Over 50 Make Good Mothers

23 Oct 2006

Women over 50 who give birth can be just as good as younger women when it comes to motherhood, say researchers from the University of California, at the annual meeting of the American Society for Reproductive Medicines. There is no evidence that women in their fifties experience higher levels of stress or experience greater health risks, compared to younger women who give birth.

The researchers examined data on 150 mothers who had received fertility treatment between 1992-2004. They gave birth in their thirties, forties and fifties.

The women were surveyed to determine their physical and mental functioning and parental stress. Their findings revealed that the women in their 50s were not less capable as parents - neither did they experience higher levels of stress than the other women.

The researchers suggest that public prejudice is the problem, not poor capacity on the part of older mothers. A large percentage of the older mothers in this study had younger partners.

Team leader, Dr Anne Steiner, said "The conclusion from this study, though it is limited and of small size, is that if we look from the perspective of stress and physical and mental functioning, it doesn't seem like we can restrict parenting based on these reasons."

Comment by the Editor of Medical News Today

The results of this research will be more convincing when larger studies are made over a longer period. The physical and mental strains of parenthood start during conception and continue for a very long time - at least 18 years and 9 months, almost two decades. If one compared two groups, for example, one thousand 55 year-old women who gave birth, to one thousand 30 year-old women who gave birth, and monitored them for 18 years, what would the difference be? Over those 18 years we would also have to find out how well their children thrived, compared to the younger mothers' children.

"Older Mothers: Physical Stress, Psychological Stress and Outcomes"
62nd Annual Meeting of the American Society for Reproductive Medicine
Link Here

University of Southern California Fertility

Written by: Christian Nordqvist
Editor: Medical News Today

Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=54835

Side Effects

2006-10-18T11:02:00.000-07:00

Side Effects Send 701,547 Americans To Hospital Each Year

18 Oct 2006

701,547 Americans suffer such side effects from prescription medications, OTC drugs and herbal supplements that they have to go to hospital emergency rooms, according to a study carried out by researchers at the Centers for Disease Control and Prevention (CDC).

You can read about this study in the Journal of the American Medical Association (JAMA).

The older a patient is, the higher is his/her risk of ending up in an emergency room because of undesirable side-effects. If you are over 65 you have two times the risk, compared to a younger person. If you are over 65 your risk of being admitted to hospital is seven times great than a younger person, said the researchers.

The study found that:

-- Insulins, painkillers containing opiates, and blood thinners were the medications that sent most people to emergency rooms

-- Other drugs that triggered emergency room visits were antibiotics containing amoxicillin, antihistamines and OTC medications for colds

-- Getting the dose right is crucial. A higher dose than the ideal is more dangerous than a lower dose.

Americans, along with citizens of most other developed nations, are great consumers of medications. In 2004, 82% of Americans took at least one prescription drug, or OTC drug, herbal medication or dietary supplement - 30% took five or more.

63 hospitals were examined in this study over a two-year-period.. A total of 21,298 undesirable side effects were reported (people treated for them in emergency rooms). The researchers concluded that this figure would be translated to 701,547 cases nationally each year.

The most common side-effects reported were:

-- Skin rashes
-- gastro-intestinal problems
-- dizziness and/or confusion

"National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events"
Daniel S. Budnitz, MD, MPH; Daniel A. Pollock, MD; Kelly N. Weidenbach, MPH; Aaron B. Mendelsohn, PhD, MPH; Thomas J. Schroeder, MS; Joseph L. Annest, PhD
JAMA. 2006;296:1858-1866.
Click here to see abstract online

Written by: Christian Nordqvist
Editor: Medical News Today

Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=54476

Interoperable EHR needed

2006-10-17T08:53:00.000-07:00

Leavitt Says Electronic Health Records System, Price Transparency Needed For Health Reform

17 Oct 2006

The U.S. health care system needs an interoperable electronic health records and billing system and more transparency on the price and quality of services, HHS Secretary Mike Leavitt told a group of physicians at the Indiana State Medical Association headquarters on Thursday, the Indianapolis Star reports. Leavitt has been touring the nation to discuss health care reform with medical professionals and business leaders. "I've come to conclude there really isn't a health care system. There's a health care sector," Leavitt said, adding, "There's really nothing that connects it together into an economic system." He also told the group that he expects Congress to begin discussions on pay-for-performance programs and possible changes to the planned 5.1% reduction in physicians' Medicare reimbursements, scheduled to take effect Jan. 1, 2007 (Lee, Indianapolis Star, 10/13).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=54113

Time Bomb

2006-10-16T14:00:00.000-07:00

Unfunded Health Care Liability For Retirees Is A "Fiscal Time Bomb," Opinion Piece States

16 Oct 2006

Retiree health benefits for state and local government employees are "a $1.4 trillion fiscal time bomb," according to a Cato Institute analysis, Cato tax policy director Chris Edwards and Cato senior fellow Jagadeesh Gokhale write in a Wall Street Journal opinion piece. Cato's analysis, based on a review of unfunded health care costs in 16 states and 11 local governments, finds that state and local governments' future health care obligations are "twice the reported underfunding," the authors write. They note that "a new Government Accounting Standards Board rule will kick in next year and reveal exactly how large this problem is" (Edwards/Gokhale, Wall Street Journal, 10/12). The rule directs governments over the next 30 years to document in their financial statements the full cost of health benefits for current and future retirees beginning at the end of 2006. Governments also must show a plan to cover such costs (Kaiser Daily Health Policy Report, 1/30). Edwards and Gokhale write, "The key problem is that the great majority of state and local governments finance their retiree health benefits on a pay-as-you-go basis," which in coming years "will create pressure to raise taxes as baby boomers age and government employees retire in droves." According to the authors, "The only good options are to cut benefits and move state and local retirement plans to a prefunded basis with personal savings plans." They conclude, "Every year that policy makers put off the tough decisions, the hole gets bigger. Hopefully, the new GASB rules will prompt them to enact the reforms needed to avert job-destroying tax increases on the next generation" (Wall Street Journal, 10/12).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=54059

FDA Changes Needed

2006-10-11T14:09:00.000-07:00

Sweeping Changes Needed At US Food And Drug Administration

11 Oct 2006

Five current or former members of the Drug Safety and Risk Management Advisory Committee to the U.S. Food and Drug Administration (FDA) called today for Congress to make sweeping changes to deal with a large number of longstanding problems at the agency.

"The current FDA system of regulating drug safety has serious limitations and is in need of changes," they say in Archives of Internal Medicine, released today. Since Congress is ultimately responsible, "it is up to Congress to take the steps necessary to reinvigorate the FDA's ability to assure the public that approved medical products are safe."

Curt D. Furberg, M.D., Ph.D., professor of public health sciences at Wake Forest University School of Medicine and the lead author, said the five decided to write the analysis after becoming discouraged by the FDA's inability to fix its own problems.

"Congress has not provided adequate funding and authority to the FDA," he said.

The group cites eight major problems impacting FDA performance, including:

* The system of initial approval of drugs often fails to detect serious adverse drug reactions.

* The same FDA center that approves drugs also has the responsibility of taking safety actions, creating a conflict-of-interest situation.

* The FDA is overly dependant on user fees from drug companies.

* The FDA is short on expertise in drug safety and public health.

"The key features of today's media stories about questionable drug safety are the same as with previous drug tragedies," Furberg said. "New drugs are introduced on the market with inadequate safety documentation; serious adverse drug reactions are later reported from the marketplace, and a large number of patients are unnecessarily injured before the drugs are withdrawn or better managed. The only difference is the name of the culprit drug."

Furberg and his colleagues recommend that Congress make five changes:

* "Give the FDA more direct legal authority to pursue violations." The FDA's own report says that drug companies committed to 1,231 post-marketing safety studies that are incomplete; 797 were never started. * "Authorize the adoption of a conditional drug-approval policy, at least for selected drugs.

* "Provide additional financial resources to support the safety operations.

* "Mandate a reorganization of the agency with emphasis on strengthening the evaluation and proactive monitoring of drug safety.

* "Require broader representation of safety experts on FDA's advisory committees."

"Larger and longer clinical trials ought to be required for drugs that will be given for chronic conditions such as high blood pressure, diabetes and coronary heart disease," said Peter A. Gross, M.D., chairman of medicine at Hackensack University Medical Center and professor of medicine and public health at UMDNJ-New Jersey Medical School and a coauthor. "Trials should be required to have adequate numbers to assure the tested drugs are reasonably safe."

"Safety evaluation should be given the same priority as efficacy evaluation," the authors wrote, calling for the creation of a Center for Drug Safety within FDA "for continuous post-marketing surveillance and regulation." They say the center should be given adequate funding and staff to take advantage of the valuable data for safety monitoring already collected in private and public databases.

The conditional drug-approval policy could be modeled on programs in other countries for those drugs that have clear benefits but also have lingering safety concerns, requiring a re-review after two to three years. "A time-limited conditional approval status would place pressure on the sponsors to conduct and report post-marketing safety studies they commit to," said Furberg.

###

Arthur A. Levin, M.P.H., director of the Center for Medical Consumers in New York, and a co-author, said the group was also calling for sufficient funding to end reliance on user fees paid by the pharmaceutical industry, calling the fees a conflict of interest. The Prescription Drug User Fee Act requires FDA to "perform something of value to industry in exchange for which industry would agree to pay the fees."

The co-authors also include Robyn S. Shapiro, J.D., of the Medical College of Wisconsin in Milwaukee, and Brian L. Strom, M.D., M.P.H., of the University of Pennsylvania in Philadelphia.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in family medicine, 20th in geriatrics, 25th in primary care and 41st in research among the nation's medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

Contact: Robert Conn
Wake Forest University Baptist Medical Center

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=53754

Pot May Help Alzheimers

2006-10-09T08:58:00.000-07:00

Back to Story - Help

Pot's Active Ingredient Could Fight Alzheimer's

2 hours, 47 minutes ago

MONDAY, Oct. 9 (HealthDay News) -- The active ingredient in marijuana -- delta-9- tetrahydrocannabinol (THC) -- may slow the progression of Alzheimer's disease, new research suggests.

According to a team at the Scripps Research Institute in La Jolla, Calif., THC preserves brain levels of an important neurotransmitter called acetylcholine. It does so by inhibiting the enzyme acetylcholinesterase, which breaks down acetylcholine.

Reporting in the current issue of Molecular Pharmaceutics, the Scripps team noted that existing Alzheimer's medicines, including donepezil and tacrine, also relieve symptoms by inhibiting this enzyme.

In their work in the laboratory, the researchers found that THC inhibits a different site on the acetylcholinesterase molecule and at lower concentrations.

They also discovered that THC prevents the formation of amyloid protein plaques that damage the brain and are a hallmark of Alzheimer's disease.

"Our results provide a mechanism whereby the THC molecule can directly impact Alzheimer's disease pathology," the study authors wrote. In addition, THC may prove valuable as a model for developing new and more effective drugs to treat the disease, they said.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

Malpractice=Errors

2006-10-06T14:03:00.000-07:00

Physician Errors Factor In Many Medical Malpractice Claims, Study Finds

06 Oct 2006

Physician errors are a factor in about 60% of medical malpractice claims that involved patients allegedly injured because of missed or delayed diagnoses, according to a study published on Monday in the Annals of Internal Medicine, the AP/Long Island Newsday reports. For the study, researchers at Brigham and Women's Hospital in Boston reviewed 307 claims from four large malpractice insurers that were closed between 1984 and 2004, 181 of which involved alleged diagnostic errors that injured patients. Researchers ignored the outcomes of the claims. The majority of the claims involved cancer patients, 30% of whom died. Although most of the claims involved several factors, the study finds the major ones involved physician errors. According to the study:

100 claims involved failure to order appropriate diagnostic tests;
81 claims involved failure to establish a plan for appropriate follow-up care;
76 claims involved failure to obtain an adequate patient history or perform an adequate physical examination; and
67 claims involved improper interpretation of diagnostic tests.

The main factors that contributed to the physician errors included failures in judgment (79%), memory problems (59%), lack of knowledge (48%), patient-related issues (46%) and patient handoffs from other physicians (20%), the study finds. Tejal Gandhi, lead author of the study and director of patient safety at Brigham and Women's, said that the use of electronic health records, improved algorithms for patient evaluations and help from nurse practitioners to ensure patients receive appropriate follow-up care might help reduce the number of physician errors. "We think there could be tools to help physicians make these decisions better," Gandhi said. Steven Sorscher, an oncologist at Washington University Medical School in St. Louis, said, "It seemed like the bottom line was that the problems were problems that would occur less if a person was just very compulsive or very diligent. It highlights the fact that the causes of serious errors are often preventable" (Walters, AP/Long Island Newsday, 10/2).

The study is available online.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=53413

Sepsis Study Funded

2006-10-05T08:59:00.000-07:00

Sepsis Is One Of The Top Causes Of Death In The US: Pitt To Receive $8.4 Million From NIH To Find Best Treatments

05 Oct 2006

Sepsis is among the top causes of death in the United States, affecting 750,000 Americans each year, of which 30 percent die. It also is one of the most expensive diseases, with a cost to U.S. hospitals of $17 billion each year. To investigate and determine the best methods for treating this life-threatening disease, the National Institute of General Medical Sciences (NIGMS), one of the National Institutes of Health, has awarded an $8.4 million, five-year grant to the University of Pittsburgh School of Medicine to head a multidisciplinary, multi-center consortium.

The Protocolized Care for Early Septic Shock (ProCESS) study will attempt to determine if there is a "golden hour" in the management of sepsis and septic shock when a prompt, rigorous, standardized treatment regimen can be used to improve clinical outcomes and halt the cascade of events that often lead to organ failure and death. The study takes a cue from the realm of coronary care, which has significantly reduced mortality from acute coronary diseases and dramatically reduced the costs of care by determining such best practices.

The investigators, led by Derek C. Angus, M.D., M.P.H., professor and vice chair of research, department of critical care medicine, University of Pittsburgh School of Medicine, share a sense of urgency about their research. They hope that the project will generate useful and comprehensive data on the clinical and biological aspects of standardized treatment for septic shock - data that can have an immediate impact on and improve the care of the critically ill.

"While we have quite an extensive understanding of the causes and course of sepsis, we have very little empirical data telling us how and when to treat this terrible disease," said Dr. Angus. "Sepsis has reached epidemic proportions in the United States, taking as many lives as heart attacks do. It is essential that we conduct this kind of study to identify the ideal way to stop the rampant inflammation before it reaches the point where it becomes so severe and aggressive that it cannot be stopped."

"This project will examine whether specific treatments, if given early enough, can stop sepsis in its tracks," said NIGMS director, Jeremy M. Berg, Ph.D. "The goal is to speed recovery, increase survival rates and improve the long-term quality of life for those who have had sepsis."

Sepsis occurs when the body's inflammatory response overreacts to an infection, resulting in a cascade of events throughout the body. The cascade begins with septic shock, vital organs become compromised and the syndrome progresses to multiple organ failure and death.

The trial, to be conducted at several leading hospitals around the country, will enroll up to 2,000 participants who present to the emergency department with septic shock. Participants will be randomized to receive alternative treatment protocols involving intravenous fluids, drugs that reverse the shock and hemodynamic monitoring during the first six hours of care. The protocols will be evaluated on three measures: clinical effectiveness as evidenced by improved mortality rates; effectiveness in reducing concentrations of biological markers that are associated with the four fundamental pathways of sepsis-related organ dysfunction - cellular hypoxia, oxidative stress, inflammation and coagulation/thrombosis; and cost effectiveness.

Collaborations with experts in the field of emergency medicine is critical. The researchers note that getting septic patients the correct care the moment they enter the hospital is essential to the success of the treatment.

"ProCESS will expand our understanding of emergency department sepsis care and could revolutionize that care," said Donald M. Yealy, M.D., professor and vice-chair of emergency medicine at the University of Pittsburgh School of Medicine, and co-principal investigator of the study. "We will be able to better understand what type of care works and why, and improve the link between emergency and ICU care. We hope to save lives, starting at the 'front' door."

"This collaborative model is one that the University of Pittsburgh has championed for years. Carrying out this clinical research is key to the mission of the department of critical care medicine, the first such department of its kind in the country," added Mitchell P. Fink, M.D., professor and chair of critical care medicine, and Watson Professor of Surgery at the University of Pittsburgh School of Medicine. "Bringing this model to sites across the country could profoundly impact critical care at the national level."

"By improving the treatment of those critically ill with sepsis, the consortium's work will have enormous implications for the thousands of patients who suffer from this infection," said NIH director, Elias A. Zerhouni, M.D.

###

CONTACT: Maureen McGaffin,

Contact: Jocelyn Uhl Duffy
University of Pittsburgh Medical Center

Bus Money

2006-10-02T15:23:00.000-07:00

UPMC to spend $1.1 million on bus, LRV ads

Monday, October 02, 2006

By Joe Grata, Pittsburgh Post-Gazette

The University of Pittsburgh Medical Center which announced record profits in August will spend $1.1 million to help the Port Authority, which is facing record deficits.


	Tony Tye, Post-Gazette "Shrink wrap" advertisements have appeared on Port Authority buses for some time, but as of today they're on light-rail vehicles as well. Dave Galando, left, of Latrobe, and Randy Miller, of Salem, attach a UPMC ad to the side of an LRV Saturday. Click photo for larger image.

In essence, UPMC has bought short-term naming rights to 180 buses and 40 light-rail vehicles for the next six months, with an option to renew the deal for another six months.

UPMC and authority officials are to announce the advertising agreement at a news conference today.

The vehicles will be "shrink wrapped" with vinyl, a popular advertising technique. UPMC's message will be displayed on one side of the buses and both sides of the light-rail vehicles.

While shrink wraps have been a Port Authority advertising tool since the mid-1990s, LRVs have carried only interior ads since modern 80-foot-long cars replaced streetcars and the Downtown subway opened in the mid-1980s.

By spending its ad dollars with the transit agency, UPMC said in a news release, it is "reaching out to residents of Allegheny County while also strongly supporting the Port Authority and underscoring the importance of its services at a time when public transportation in Pennsylvania faces an acute funding crisis."

UPMC announced in August that its profits jumped 77 percent, to $512 million, during the past fiscal year. Special federal highway funds keeping the Port Authority afloat will run out Dec. 31, when it faces a record $31.5 million operating deficit for the last six months of the fiscal year.

The $1.1 million outlay is the single biggest advertising deal in the authority's history and will help mitigate the financial crisis somewhat.

"It's a tremendous commitment and demonstrates their understanding of the importance of public transportation," authority Chief Executive Officer Steve Bland said. "It's a great first step toward public-private partnerships and it's coming without all the [government] paperwork."

He noted that the Port Authority, the nation's 15th largest transit system, carries many UPMC employees and patients to hospital facilities in Oakland and elsewhere.

The 40 LRVs that will carry the UMPC ads represent about half of the fleet. Combined with ads already carried on 27 buses, UPMC's message will appear on a total of 207 buses, more than one-fifth of the bus fleet.

An advertising agency began shrink-wrapping the buses and LRVs over the weekend. The first ones are to be on the streets and rails this morning.

$$$

2006-10-02T15:22:00.000-07:00

Feds give Pitt $8.4 million to study sepsis infections

Monday, October 02, 2006

Pittsburgh Post-Gazette

The University of Pittsburgh School of Medicine has received an $8.4 million federal grant to investigate the best method for treating sepsis infections.

A release from Pitt today said sepsis is among the top causes of death in the United States, affecting 750,000 Americans each year, of which 30 percent die. It also is one of the most expensive diseases, with a cost to U.S. hospitals of $17 billion each year.

The grant from the National Institute of General Medical Sciences (NIGMS), one of the National Institutes of Health, will allow researchers to attempt to determine if there is a "golden hour" in the management of sepsis and septic shock "when a prompt, rigorous, standardized treatment regimen can be used to improve clinical outcomes and halt the cascade of events that often lead to organ failure and death," the release said.

Sepsis occurs when the body's inflammatory response overreacts to an infection, resulting in problems vital organs becoming compromised

Quality of Patient Care

2006-10-01T12:12:00.000-07:00

Quality Of Patient Care - Strengths And Weaknesses In Treatment Of 850,000 Patients Across The USA
01 Oct 2006

For millions of patients, from diabetics to those battling depression, life and death often hinges on the smallest of details. Those details are a part of a 4-year study recently conducted by researchers at the Medical University of South Carolina (MUSC) which looked at care provided at healthcare practices within the Practice Partner Research Network (PPRNet).

Since 2002, five MUSC investigators, along with a colleague from the University of Southern California, have examined 99 outpatient primary care practices across the country linked through Practice Partner, a provider of electronic medical record software. In total, the practices represent approximately 850,000 patients. Researchers evaluated performance in the areas of diabetes, cancer, heart disease, immunizations, obesity, respiratory and infectious diseases, mental health and inappropriate medication prescribing among elderly patients. Over half of the practices participated in optional on-site visits, and less than half participated in annual network meetings. Of the 36 care processes and outcomes measured, 29 experienced significant improvements.

"The practices were able to make substantial improvements in the quality of care they provide to their patients, particularly in the areas of cancer screening and immunization delivery," said Paul J. Nietert, PhD, one of the co-investigators on the project. "With so many healthcare facilities across the country focused on improving quality of care for their patients, our findings are extremely timely and show just how responsive and willing practitioners are to implement changes to better serve their patients."

Practices showed no improvement when it came to processes such as blood pressure monitoring, providing Hepatitis-A vaccines to patients with liver disease, and prescribing beta blockers for patients with heart failure and antidepressants for clinically depressed patients.

"For certain measures like blood pressure monitoring, the practices didn't improve much because they were already performing extremely well at the beginning of our study," said Dr. Nietert. "For other measures, there is clearly still room for improvement."

The study was funded by the Agency for Healthcare Research and Quality (AHRQ) as part of its Partnerships for Quality Initiative. In the future, lessons learned in this study and goals achieved by practices may be used for quality improvement in other outpatient settings as well.

About The Medical University of South Carolina (MUSC)

Founded in 1824 in Charleston, The Medical University of South Carolina is the oldest medical school in the south. Today, MUSC continues the tradition of excellence in education, research and patient care. MUSC is home to over 3,000 students and residents, as well as nearly 10,000 employees, including 1,300 faculty members. As the largest non-federal employer in Charleston, the University and its affiliates have collective budgets in excess of $1.3 billion per year. MUSC operates a 600-bed medical center, which includes a nationally recognized Children's Hospital and a leading Institute of Psychiatry. http://www.musc.edu
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=53034

Medicare Opinions

2006-09-27T10:34:00.000-07:00

Letters to the editor, 09/27/06

Wednesday, September 27, 2006

Pittsburgh Post-Gazette

Medicare for all would work only with priority changes

Ironically, on the same day I read Dr. Bill Wood's commentary "Medicare for All" (Sept. 13 Midweek Perspectives), I received a copy of Surgery News with the headline "CMS [Centers for Medicare and Medicaid Services] Proposes 5.1 Percent Physician Pay Cut for 2007."

As much as I agree with Dr. Wood's assessment of our current medical system, powered by insurance giants making huge profits from our work and our patients' premiums, I hesitate supporting a public single-payer system that will continue to cut physician reimbursement.

Currently, physicians cannot afford to accept new Medicare patients -- how will it be if all patients were covered by government insurance? It would drive many physicians out of practice.

Likely, this system works well in other countries because other governments actually make health care and education a priority.

We have an administration and a Congress that are more willing to use taxpayer money for funding large, flat-screen TVs for Halliburton employees in Iraq to watch the Super Bowl than fund me to order a CT scan on my patient for abdominal pain or perform a physical and a skin biopsy on my elderly patient at the same visit.

Before I can support Dr. Wood's proposal, I have to see some big changes in our government priorities. As an American people, if we really want quality health care for all, then we must go to the polls and prove it.

VERONICA SANTEE, M.D.
West View

Not the answer

One of the main flaws in Dr. Bill Wood's piece calling for "Medicare for All" can be found in the same day's paper on Page A-6. There, in a story from The Washington Post, we hear once again that Medicare is running out of money and raising premiums ("Medicare Premiums Rise 5.6 Percent for Most," Sept. 13). The same article tells us that healthy seniors are expected to start opting out of Medicare, leaving behind only the sickest/poorest and further raising the program's costs. It doesn't begin to get into other problems, such as the fact that thousands of doctors are likely to stop accepting Medicare in the next few years as Medicare payments drop by more than 20 percent.

"Medicare for All" is a terrible idea when the Medicare we have now is falling apart. This past year, I served as one of many national spokespeople for Cover the Uninsured Week, and I agree with Dr. Wood that we face a crisis in American health care. We do need a new system, but a single-payer "solution" would leave us sicker and worse off than we are now. We'd replace uncaring, unresponsive health insurers with uncaring, unresponsive government agencies.

There are better options, ways that force insurers to actually serve patients and keep us healthy in order to earn our precious health-care dollars. Those solutions are more complicated, but that's the choice we have -- between a solution that's complex and will work and the single-payer idea that's simple but wrong.

ALIK WIDGE
Squirrel Hill

The writer is a University of Pittsburgh medical student.

Patients Quit Taking Drugs Too Early

2006-09-26T10:56:00.000-07:00

Many patients quit medicine too early

By CARLA K. JOHNSON, Associated Press Writer

Many patients stop taking their medicine far sooner than they should, researchers say, and that decision can be deadly when the drugs treat heart disease or diabetes.

It took only one month after leaving the hospital for 1 out of 8 heart attack patients to quit taking the lifesaving drugs prescribed to them, a study of 1,521 patients found.

"One month is very surprising," said study co-author Dr. Michael Ho of the Denver Veterans Affairs Medical Center.

The heart patients who stopped taking three proven drugs aspirin, beta blockers and statins were three times more likely to die during the next year than patients who stayed on the pills.

The study didn't examine why people stopped taking their medicine, but the patients who quit were more likely to be older, single and less educated.

They're in good company. Former President Bill Clinton a younger, married and well-educated patient was prescribed a statin for high cholesterol when he left office. But he stopped taking it at some point. And at age 58, he had to have quadruple bypass surgery because of severely clogged arteries that doctors said put him danger of a heart attack.

The study of heart patients appears in Monday's Archives of Internal Medicine. The issue features a group of studies on patients who stopped taking their medications.

One of the studies reviewed medical records of 11,532 diabetes patients. It found that those who didn't take their drugs hypoglycemics, blood pressure drugs and statins had higher rates of hospitalization and death. The link was not as pronounced as in the heart attack research, but was still significant.

In two other studies, researchers found that cost prevents many Medicare beneficiaries from taking their pills and that doctors too often neglect to explain the basics about new drugs.

In recordings of 185 patient visits, doctors failed to mention a new drug's side effects or how long to take the drug in about two-thirds of the visits.

One entire conversation about a new prescription captured on audiotape went like this:

Doctor: "If I'm writing antibiotics, are you allergic to penicillin?"

Patient: "No. I'm not allergic to anything."

Doctor: "Okey dokey."

Study co-author Dr. Derjung Tarn of the University of California, Los Angeles, said, "We need to find quick and easy ways to communicate in ways patients can easily understand and remember."

The research suggests that patients and their doctors must work harder, said Dr. Patrick O'Connor of HealthPartners Research Foundation in Minneapolis, who wrote an editorial in the journal.

"Patients need to ask, 'What are the most important medicines in my treatment, the ones that will help me live long enough to see my grandchildren grow up?'" O'Connor said.

Doctors, he said, need to tell patients more about the drugs they prescribe and then follow up with them.

"You think they know what a statin is from watching television, but they don't know that Lipitor is a statin or that Zocor is a statin," O'Connor said of doctors.

He also said that if a patient is taking six different pills, doctors should give advice about which ones to stop if the cost gets too high.

Some patients assume they quit their pills if the doctor says their cholesterol looks good, said Dr. Kim Eagle of the University of Michigan.

"Generally, these medications need to be continued to have their benefit," he said of drugs that fight heart disease. But many factors, he said, conspire against regular drug-taking: cost, side effects, depression, carelessness and a desire not to be someone who takes a lot of pills.

In a study of 13,835 Medicare enrollees, 29 percent of disabled people and 13 percent of the elderly reported they had skipped doses or hadn't filled a prescription because of cost. That research was done before the new Medicare drug benefit took effect and the researchers recommend more study to see what effect the new benefit might have.

One issue arising recently and causing concern among health advocates is the coverage gap in the Medicare drug benefit, which leaves the elderly and disabled paying thousands of dollars out of pocket after their drug costs reach $2,250.

Walmart Offers $4 Generic Prescriptions

2006-09-21T10:01:00.000-07:00

Wal-Mart to Sell Generic Drugs for $4

Sep 21, 10:38 AM (ET)

By ANNE D'INNOCENZIO

TAMPA, Fla. (AP) - Wal-Mart announced today that it will start a test program in Florida, where it will sell generic prescription drugs for $4 for a 30-day supply. The test will start tomorrow in 65 Tampa Bay-area stores and is to expand to the whole state by January.

In a statement, CEO Lee Scott says the world's largest retailer intends to "take the program to as many states as possible next year."

On average, generic drugs tend to cost between $10 and $30 for a month-long supply.

The world's biggest retailer said that it will test the program in Florida that will make 291 generic drugs available, which are used to treat a variety of condition from allergies to high-blood pressure. It will also be available to the uninsured.

The program will be launched on Friday at 65 Wal-Mart, Neighborhood Market and Sams' Club pharmacies in the Tampa Bay area in Florida and will be expanded to the entire state in January.

The company said it plans to take the program to as many states as possible next year.

"Each day in our pharmacies we see customers struggle with the cost of prescription drugs," said Wal-Mart CEO H. Lee Scott, Jr., in a statement. "By cutting the cost of many generics to $4, we are helping to ensure that our customers and associates get the medicines they need at a price they can afford."

The initiative would be the fourth time since last October that Wal-Mart has moved to improve health benefits.

Wal-Mart's recent moves to improve its health care plan include relaxing eligibility requirements for its part-time employees who want health insurance, and extending coverage for the first time to the children of those employees. Part-time employees, who had to work for Wal-Mart for two years to qualify, now have to work at the company for one year. This year, Wal-Mart also expanded a trial run of in-store clinics, aimed at providing lower cost non-emergency health care to the public.

Last October, Wal-Mart offered a new lower-premium insurance aimed at getting more of its work force on company plans.

But critics argue that Wal-Mart's coverage calls for a deductible that requires workers to pick up the first $1,000 in medical expenses, and the deductible rises to a maximum of $3,000 for families.

Union-backed Wake Up Wal-Mart, one of its most vociferous critics, have called upon Bentonville, Ark.-based Wal-Mart to offer better health care coverage and higher pay to employees.

Critics contend that the company's benefits are too stingy, forcing taxpayers to absorb more of the cost as the workers lacking coverage turn to state-funded health care programs.

This past summer, Wal-Mart won a successful fight against a first-of-its-kind state law that would have required the retailer to spend more on employee health care in Maryland. A federal judge ruled in July that it was invalid under federal law. But other states are considering similar legislation aimed at the company.

Medicare--Worst Social Legislation

2006-09-14T11:45:00.000-07:00

O'Neill: Part D 'worst social legislation' in his lifetime

Wednesday, April 26, 2006

By Christopher Snowbeck, Pittsburgh Post-Gazette

The federal government's new Medicare prescription drug program is another example of how the country is missing chances for real savings and improvement in health care, former U.S. Treasury secretary and Alcoa chairman Paul O'Neill said yesterday.

"It's the worst piece of social legislation in my lifetime," Mr. O'Neill said of the new Part D program during a talk at the Duquesne Club, Downtown. "This thing is just a nightmare."

Mr. O'Neill only touched briefly on Medicare during his speech at Duquesne University's 16th Annual Donahue Business Society Spring Luncheon. But he spoke more broadly about how the nation's health system could be reformed in ways that would improve care while slashing its price.

Practicing the best medicine possible -- including the elimination of hospital-acquired infections and medication errors -- would could cut health-care spending in half while helping patients, Mr. O'Neill said, repeating a message he's delivered for several years.

The savings could help guarantee access to health care for uninsured Americans, he added. The money saved also could help bring clean water to sub-Saharan Africa -- another cause that Mr. O'Neill has championed since leaving the Bush administration in late 2002.

Hospital-acquired infections were one of the issues that Mr. O'Neill challenged hospitals to address through the Pittsburgh Regional Healthcare Initiative, a nonprofit group that has led a variety of quality improvement efforts since the late 1990s. Mr. O'Neill resigned as its chief executive officer in late 2004 and no longer serves on the initiative's board of directors.

"I got push-back from the major players in town who said, 'We don't want you setting our priorities,' " he said.

In 2005, Mr. O'Neill created a for-profit company that consults with hospitals on quality issues.

Physician's "Reluctant" to Disclose

2006-09-13T20:55:00.000-07:00

Physicians "Reluctant" To Disclose Medical Errors To Patients, Editorial States

13 Sep 2006

A recent Archives of Internal Medicine survey on physician disclosure of medical errors to patients indicates that "doctors seem reluctant to provide what patients deserve and say they want: an explicit acknowledgement of error, information about why it happened and an apology from their physician," according to a New York Times editorial (New York Times, 9/9). For the survey, researchers from the University of Washington interviewed 1,404 surgeons and general practitioners in Canada, which limits medical liability and discourages medical malpractice lawsuits, and 1,233 surgeons and general practitioners in Washington and Missouri, two states considered to have high malpractice insurance costs. Researchers asked survey participants to respond to specific scenarios in which they had committed medical errors (Kaiser Daily Health Policy Report, 8/18). "The doctors talked a good game" -- 98% said that they support disclosure of serious medical errors to patients -- but "most had something less than full disclosure in mind," the editorial states, adding, "If the error were apt to become obvious ... the doctors were far more apt to admit error and apologize than if the error was too subtle for most patients to recognize." The editorial states, "Changes in medical education to encourage disclosure of errors would surely help, as would computerized systems to detect errors that might otherwise remain unnoticed" (New York Times, 9/9).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medic

Pitt Awarded Designation

2006-08-30T09:23:00.000-07:00

University Of Pittsburgh Named Parkinson Disease Center For Advanced Research

Main Category: Parkinson's Disease News
Article Date: 30 Aug 2006 - 9:00am (PDT)
| email this article | printer friendly | view opinions |

The University of Pittsburgh has been named an American Parkinson Disease Association (APDA) Advanced Center for Parkinson's Disease Research, a designation that places it in an elite group with eight other leading institutions in the United States.

J. Timothy Greenamyre, M.D., Ph.D., UPMC Endowed Professor of Neurology and chief, movement disorders division, University of Pittsburgh School of Medicine, will direct all aspects of the center and chair the center's executive committee. Dr. Greenamyre, an internationally renowned Parkinson's disease researcher, was recruited to Pitt's faculty in 2004 to direct the Pittsburgh Institute for Neurodegenerative Diseases (PIND).

"Being selected as an APDA Advanced Center for Parkinson's Disease research builds on a long history of excellence in Parkinson's disease research at the University of Pittsburgh and will allow us to capitalize on our growing strengths in the basic and clinical aspects of Parkinson's disease research," said Dr. Greenamyre, who also is chair of the Scientific Advisory Committee of the Parkinson Study Group and a member of the Scientific Advisory Board of the Michael J. Fox Foundation. "We hope that our research will make a difference in the lives of people with Parkinson's disease and for their families as well."

The other APDA centers are located at Boston University School of Medicine; Emory University School of Medicine, Atlanta; UCLA School of Medicine, Los Angeles; the University of Alabama at Birmingham; University of Virginia Medical Center, Charlottesville; UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J.; and Washington University Medical Center, St. Louis.

As an APDA Advanced Research Center, the university will receive $90,000 per year for five years, for a total of $450,000.

The grant will support both clinical and basic science research, with studies likely to focus on developing methods for early Parkinson's disease (PD) diagnosis, characterizing the swallowing and respiratory problems of PD, understanding how iron accumulates in the PD brain, and on evaluating gene transfer as a way to stop the neurodegeneration process of Parkinson's.

In addition to the $450,000 grant, the APDA also awarded Sarah Berman, M.D., Ph.D., assistant professor of neurology, and Rehana Leak, Ph.D., a research associate in the department of neurology, one-year $50,000 research grants.

Dr. Berman will use the award to study mitochondrial dynamics in vulnerability and protection of aging in PD, and Dr. Leak will conduct her research on preconditioning-induced neuroprotection in models of PD.

The mission of PIND is to transform cutting-edge science into novel therapies and diagnostics that directly benefit individuals affected by neurodegenerative diseases. PIND's mission is bolstered by and integrated with clinical programs in the department of neurology, including the Alzheimer's Disease Research Center, the Comprehensive Movements Disorders Clinic, the UPMC Stroke Institute and the Muscular Dystrophy Association ALS Center.

###

The American Parkinson Disease Association, Inc. was founded in 1961 to "ease the burden and find a cure" for Parkinson's disease. Headquartered in New York, the organization focuses its energies on research, patient support, education and raising public awareness of the disease. Each year the APDA scientific advisory board reviews grant requests and submits recommendations for funding researchers whose work shows promise of making scientific breakthroughs or finding improved treatments for Parkinson's disease.

Contact: Lisa Rossi
University of Pittsburgh Medical Center

HHS Rules on Electronic Medical Records

2006-08-04T13:12:00.000-07:00

HHS Announces Rules To Allow Donation Of Electronic Health Record Products, Training To Physicians
04 Aug 2006

HHS on Tuesday announced final rules that seek to help physicians implement electronic health record systems, CQ HealthBeat reports. The rules establish exceptions and safe harbors for two federal fraud and abuse laws that regulate the donation of health care information technology and services. Under the rules, published by CMS and the HHS Office of Inspector General, hospitals and certain other groups can donate interoperable EHR software, hardware and training to physicians through the exceptions and safe harbors. The rules "will sunset on Dec. 31, 2013, in line with the president's goal of adopting the technology by 2014," CQ HealthBeat reports. HHS Secretary Mike Leavitt in a conference call said, "This is a big day for the advancement of health information technology." Karen Ignagni, president and CEO of America's Health Insurance Plans, said that the rules will "create a uniform template to support e-prescribing and the creation of electronic health records."
Criticism of Health Care IT Bill
In related news, Leavitt and Ignagni on Tuesday criticized provisions related to interoperability standards in the House version of a health care IT bill passed last month. Leavitt said, "Unfortunately, the House bill contains a serious flaw of treating health IT as if it doesn't need to be interoperable. That's like having a cell phone that can't talk with other cell phones from another network." Leavitt said that House and Senate conferees should "re-examine the bills and make interoperability a specific requirement" (Carey, CQ HealthBeat, 8/1).

NAHIT Details Effort
Last week, the National Alliance for Health Information Technology on Capitol Hill detailed an effort "to create a standard language and interoperability to a level where machines can communicate and interpret information," CQ HealthBeat reports. NAHIT in the next three years "is set to build industry standards, multiorganizational collaboration and best practices, and undertake the task of fully informing the government of how health IT operates," according to CQ HealthBeat (CQ HealthBeat, 7/28).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=48693

Mistake??

2006-08-02T13:24:00.000-07:00

A surgeon removes a kidney instead of the gallbladder

It took 3 days before the mistake was noticed:

A physician assistant and a nurse present during the surgery said the surgeon "was working in the exact location you would expect...(the gallbladder) to be located," according to the DPH'’s investigation report.

However, the patient had a lot of internal inflammation and an unusual internal anatomy, which made the surgery more complex, Muller said.

"From a medical standpoint, absolutely it'’s unusual to misidentify an organ," Muller said. "But certainly, this was an unusual case."

Visit HonestMED.com

Medicaid Fraud

2006-07-31T12:36:00.000-07:00

Mississippi Files Medicaid Fraud Lawsuit Against Eli Lilly Over Marketing For Off-Label Prescriptions
31 Jul 2006

Mississippi on Tuesday filed a lawsuit in Lafayette County Circuit Court against Indianapolis-based Eli Lilly over allegations that the pharmaceutical company improperly marketed the antipsychotic drug Zyprexa for "off-label" uses, "defraud[ing] the state out of millions of dollars in Medicaid reimbursements," the Jackson Clarion Ledger reports. The suit alleges that representatives for Eli Lilly convinced Mississippi doctors to prescribe the drug to patients who suffered from anxiety, mood swings and disturbed sleep while the drug was approved only for treatment of bipolar disorder and schizophrenia. The suit also alleges that the pharmaceutical company did not properly emphasize the dangers of the drug, such as an increased risk of diabetes. Those Medicaid beneficiaries who became ill from the drug consequently increased the state's Medicaid expenditures, the suit states. The suit alleges damages of $30 million in prescription costs alone, and the state also will seek civil penalties, punitive damages and litigation costs, Tim Balducci, Mississippi special assistant attorney general, said. Zyprexa, which is among the top drugs paid for by Medicaid, was improperly marketed "in an attempt to expand the market share of the drug," Balducci said. He added that Eli Lilly targeted the state of Mississippi because its Medicaid system does not stringently oversee the prescription of drugs for off-label uses. Eli Lilly has 30 days to respond to the suit. A spokesperson for the company did not comment on the suit (Joyner, Jackson Clarion Ledger, 7/25).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=48251

Medical Proxy Info

2006-07-29T14:29:00.000-07:00

Identifying Medical Proxy Should Be Part Of Routine Medical Care

29 Jul 2006

One-third of married individuals choose someone other than their spouse as a surrogate for medical decision-making. And more often than not, when adult patients chose a parent, sibling or child, they prefer their mothers, sisters and daughters to serve as medical proxies over their fathers, brothers and sons.

These are among the results of a study on advance care planning conducted by Northwestern University researcher K. Michael Lipkin, M.D., available in the online early edition of the Journal of General Internal Medicine (http://www.blackwell-synergy.com/toc/jgi/0/0). Lipkin is assistant professor of clinical preventive medicine at Northwestern University Feinberg School of Medicine.

The finding that 33 percent of the married patients in the study did not choose their spouse as surrogate is noteworthy, because physicians regularly look to spouses as informal surrogates.

Additionally, over a quarter of survey participants chose someone other than the person identified as an emergency contact to act as proxy in medical decision-making.

"When patients choose a surrogate who is not the person doctors would usually consult or who would not become empowered as a substitute decision-maker under state laws, physicians are alerted to engage these patients in an advance care planning process that ensures the formal appointment of their desired health care agent," Lipkin said.

"Emphasis on end-of-life care, terminal illness and the use or discontinuation of life-sustaining medical treatment [as in the Terri Schiavo case] has obscured the need for advance planning in the regular care of all competent adult patients," Lipkin said.

Lipkin commented that doctors do not ordinarily consider advance planning unless patients are elderly or seriously ill. At the same time, he and others have found, most patients are willing to discuss plans for future medical care and are waiting for their physicians "to begin the conversation and to raise the necessary questions."

Lipkin designed and conducted a survey of over 300 participants to determine whether they were willing and able to designate a specific person to act as a surrogate for medical decision-making at the time of a routine health care appointment.

Study participants were of different ages (19 to 96 years) in various states of health, who were electively seeking medical evaluation or treatment and who were considered competent to make their own medical decisions.

Of the patients interviewed, over 90 percent supported the idea of asking patients to designate a proxy for health care on a routine basis. Yet, less than 26 percent of patients had previously been asked to identify a surrogate in the course of ordinary medical care.

When asked if they would want to name a proxy for health care "now," that is, if their doctor asked them to at this particular time, more than 85 percent answered "yes."

Lipkin said that identifying a proxy for health care as part of routine medical inquiry offers several immediate clinical advantages. First, the door is opened for ongoing advance care planning discussions between patients and their doctors. Second, the benefits of choosing a health care agent are made available to all competent patients -- not only to the terminally ill, the very sick or the very old. Third, documentation of a competent patient's proxy preference in his/her medical record constitutes "clear and convincing evidence" of prior patient wishes in case of incapacitation -- providing a safety net until more definitive planning is accomplished.

Lipkin regards the routine identification of a proxy for health care as a door-opening first step for ongoing conversations between doctors, patients and families - conversations that emphasize the important relationships and values of patients and their loved ones. The nature of this process encourages continuing interchange, strengthens the patient's relationship with his/her physician and promotes continuity of care.

"Advance care planning is not about documents -- it is about persons and their relationships," Lipkin said.

###

Participants for this study were patients at the General Eye Clinic of the University of Chicago, where Lipkin had been a faculty member of the Pritzker School of Medicine.

Contact: Elizabeth Crown
Northwestern University

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=48171

Visit HonestMED.com

Tragic proof of need

2006-07-24T11:33:00.000-07:00

As Webmaster for HonestMED, I had an unfortunate experience to prove the need for electronic medical records. A friend of mine, Bob N., had a heart attack while attending our morning coffee club over the weekend. Another friend performed CPR, while others called 911, and Bob was taken away in an ambulance. Unfortunately, Bob N. had neither his wallet nor keys on him, and he was unconscious subsequent to the heart attack. Nobody knew how to contact his relatives, nor did anyone know his medical history. He was admitted to the hospital as a "John Doe," and even after learning his identity, the hospital was unable to learn abou relatives or medical info. Bob N. underwent surgery, which seems successful, but he remains unconscious, and doctors are being very conservative in treating him. This situation is an extreme example, but certainly confirms the need for an electronic medical record in case of emergency. In addition, even though it has been made known that Bob had knee replacement surgery locally several years ago, nobody has been able to get medical information from local doctors or hospitals; another problem which shouldn't be occurring. Which only convince us at HonestMED that our electronic medical records project is of vital importance and should be completed as soon as possible.

--Phil Taylor, Webmaster
HonestMED

1.5 million medication errors

2006-07-21T13:10:00.000-07:00

Medication errors harm 1.5 million Americans every year

Medication errors made in hospitals and clinics around the country harm at least 1.5 million Americans every year, according to a study by the National Academy of Sciences.

"There are at least 1.5 million preventable ADEs (adverse drug events) that occur in the United States each year," 7,000 of which result in deaths, the academy's Institute of Medicine said in Thursday's report.

"The true number may be much higher," it added.

In terms of money, the mistakes cost the US health care system around 3.5 billion dollars a year, without factoring in the loss of work-hours by its victims, said the institute, which offers the government independent counselling on health issues.

"What is most striking about these statistics is that much of this harm is preventable, since a variety of strategies and techniques exist for reducing medication errors," the researchers said.

Health providers should be more forthcoming about medication errors and their consequences, and "make greater use of information technologies in prescribing and dispensing medications."

It highly recommended the use of electronic prescriptions, or e-prescriptions, to "avoid many of the mistakes that accompany handwritten prescriptions." All prescribers and pharmacies, it added, should use e-prescriptions by 2010.

"Furthermore, by tying e-prescriptions in with the patient's medical history, it is possible to check automatically for such things as drug allergies, drug-drug interactions and overly high doses," it added.

The Institute of Medicine estimated that, on average, at least one patient per hospital per day risks being prescribed or administered the wrong medication.

Better form of Vitamin E

2006-07-18T15:45:00.000-07:00

Natural Vitamin E Tocotrienol Reaches Blood At Protective Levels
18 Jul 2006

Two recent studies offer new evidence suggesting an alternative form of natural vitamin E can be taken by mouth and will reach the blood in humans at levels determined to protect against stroke and other diseases.

Vitamin E occurs naturally in eight different forms. The primary vitamin E on drugstore shelves is called tocopherol, or TCP. But another natural form of vitamin E surfacing as a potent neuroprotective agent in repeated Ohio State University Medical Center studies is tocotrienol, or TCT.

This form, while not abundant in the American diet, occurs naturally in palm oil; this vegetable oil is increasingly used in prepared foods because it has no trans fat.

In the first study of this form of the nutritional supplement in humans, Ohio State researchers determined that a moderate dose of tocotrienol reached concentrations in human blood plasma that would be more than adequate to protect against neurological damage that follows stroke. These findings were published in the May issue of the journal Antioxidants & Redox Signaling.

In a separate study, the scientists determined that TCT is effective at two concentrations, one at which it functions as an antioxidant, and another, lower concentration at which the supplement offers non-antioxidant protection. Both functions of TCT are directed against neurodegeneration. These findings were published June 26 in an online edition of the Journal of Neurochemistry.

"We have determined that when administered orally, tocotrienol can reach concentrations needed to serve these dual protective functions," said Chandan Sen, professor and vice chair of surgery, deputy director of the Davis Heart and Lung Research Institute at OSU, and senior author of both studies. "It is a regular dietary ingredient in Asia, so it can safely be a part of a daily diet within prepared foods or as a supplement in the United States . Can it be therapeutically used to prevent stroke? Results from animal studies are encouraging, but it is still too soon to tell for humans. More mechanistic and outcomes studies are warranted."

In the first study, collaborating scientists at Wayne State University fed participants 400 milligrams of a time-release formulation of a supplement containing primarily TCT. Researchers collected blood samples from the participants two, four, six and eight hours after supplementation.

Sen said the maximum TCT concentrations in the bloodstream of supplemented patients averaged concentrations between 12 and 30 times higher than that needed to completely prevent stroke-related neurodegeneration as determined by earlier research.

Conventional wisdom has suggested that TCT, if eaten, cannot be carried to organs because the protein known as tocopherol transfer protein (TTP), which delivers TCP throughout the body, doesn't transport TCT very well.

"Our results demonstrate that TCT is efficiently delivered to the bloodstream despite the fact that the transfer protein has a lower affinity for TCT than it has for TCP," Sen said. Absorption of TCT is increased when the supplement is taken with fat-containing food, so the research participants took the study supplement with a high-fat (60 grams) meal to increase the efficiency of absorption.

The findings corresponded closely with previous work as well as the more recent study that sought to determine the levels at which TCT functions as an antioxidant, an agent that protects cells against the effects of free radicals. Free radicals are potentially damaging by-products of energy metabolism that can damage cells and are implicated in the development of cardiovascular disease and cancer. The tocopherol, or most common, form of vitamin E is known for its antioxidant properties.

In previous studies, the scientists found that moderate oral doses of TCT before a stroke significantly reduced stroke injury in hypertensive rats.

In the more recent study published in the Journal of Neurochemistry, researchers observed the effects of TCT on neurological damage that can be caused in two different ways: through the presence of homocysteic acid, which in excess can cause vascular and neuronal lesions associated with cardiovascular disease, and the fatty acid linoleic acid, which can directly stimulate damaging free radical activity. Fatty acids are related to stroke: They rapidly accumulate when a clot in a vessel stops blood flow to the brain, and play a role in irreversible brain injury.

To observe the TCT's effectiveness, rodent neural cells were pretreated with extremely low concentrations of TCT; these cells avoided the cell death associated with toxicity caused by homocysteic acid. But to reduce free-radical activity and resulting neurotoxicity, the scientists found that a higher concentration of TCT was needed: Tocotrienol does not exhibit antioxidant properties until it reaches a concentration 10 to 25 times stronger than the concentration that prevented the cell death signal.

###

The National Institutes of Health supported this research. Ohio State co-authors of the Journal of Neurochemistry study were Savita Khanna, Sashwati Roy, Narasimham L. Parinandi and Mariah Maurer, all with the Davis Heart and Lung Research Institute. Ohio State co-authors of the Antioxidants & Redox Signaling paper were Viren Patel, Khanna and Roy, all of the Laboratory of Molecular Medicine.

Contact: Emily Caldwell
Ohio State University
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=47433

Stem Cells in Hair Follicles

2006-07-15T16:53:00.000-07:00

New Source Of Multipotent Adult Stem Cells Discovered In Human Hair Follicles
15 Jul 2006

Researchers at the University of Pennsylvania School of Medicine have isolated a new source of adult stem cells that appear to have the potential to differentiate into several cell types. If their approach to growing these cells can be scaled up and proves to be safe and effective in animal and human studies, it could one day provide the tissue needed by an individual for treating a host of disorders, including peripheral nerve disease, Parkinson's disease, and spinal cord injury.

"We are very excited about this new source of adult stem cells that has the potential for a variety of applications," says senior author Xiaowei (George) Xu, MD, PhD, Assistant Professor of Pathology. "A number of reports have pointed to the fact that adult stem cells may be more flexible in what they become than previously thought, so we decided to look in the hair follicle bulge, a niche for these cells." Xu and colleagues report their findings in the latest issue of the American Journal of Pathology.

Hair follicles are well known to be a source for adult stem cells. Using human embryonic stem cell culture conditions, the researchers isolated and grew a new type of multipotent adult stem cell from scalp tissue obtained from the National Institute of Health's Cooperative Human Tissue Network.

The mutipotent stem cells grow as masses the investigators call hair spheres. After growing the "raw" cells from the hair spheres in different types of growth factors, the investigators were able to differentiate the stem cells into multiple lineages, including nerve cells, smooth muscle cells, and melanocytes (skin pigment cells).

The differentiated cells acquired lineage-specific markers and demonstrated appropriate functions in tissue culture, according to each cell type. For example, after 14 days, 20% to 40% of the cells in the melanocyte media took on a weblike shape typical of melanocytes. The new cells also expressed biomarkers typical of pigment cells and when placed in an artificial human skin construct, produced melanin and responded to chemical cues from normal epidermis skin cells.

After 14 days, about 10% of the stem cells in the neuronal cell line -- a type of cell not present in skin or hair -- grew dendrites, the long extensions typical of nerve cells and expressed neuronal proteins. The neurotransmitter glutamate was also present in the cells, but the neurotransmitter dopamine was not detected.

Thirdly, about 80% of the stem cells grown in the muscle media differentiated into smooth muscle cells. These new muscle cells also contracted when placed in a collagen matrix.

Overall, the researchers showed that human embryonic stem cell media could be used to isolate and expand a novel population of multipotent adult stem cells from human hair follicles. "Although we are just at the start of this research, our findings suggest that human hair follicles may provide an accessible, individualized source of stem cells," says Xu. The researchers are now working on inducing other cell types from the hair sphere cells and testing the cells in animal models. Study co-authors are Hong Yu, Suresh M. Kumar, and Geza Acs, all from Penn; and Dong Fang, Ling Li, Thiennga K. Nguyen, and Meenhard Herlyn, all from the Wistar Institute, Philadelphia.

###

This release and related images can also be seen at: http://www.uphs.upenn.edu/news.

PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors [Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.

Contact: Karen Kreeger
University of Pennsylvania School of Medicine
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=47175

Nondisclosure?

2006-07-13T08:59:00.000-07:00

Authors Of JAMA Study On Antidepressant Use During Pregnancy Did Not Disclose Relationships With Drug Companies

13 Jul 2006

Most of the 13 physicians who co-authored a study regarding depression relapse risk for women who stop taking their medication during pregnancy -- published in the Feb. 1 edition of the Journal of the American Medical Association -- did not disclose more than 60 financial relationships to pharmaceutical companies, the Wall Street Journal reports (Armstrong, Wall Street Journal, 7/11). The study, funded by the National Institute of Mental Health, questions the commonly held belief that hormones produced during pregnancy protect women from depression. Lee Cohen, director of Massachusetts General Hospital's Center for Women's Mental Health, and colleagues between 1999 and 2003 monitored 201 pregnant women with a history of depression. The women were taking medications such as Prozac, Zoloft, Effexor and Paxil. Researchers found that 68% of the women who stopped taking antidepressants relapsed into depression during pregnancy. In addition, 26% of the women who continued taking their medication during pregnancy also became depressed (Kaiser Daily Women's Health Policy Report, 2/2). According to the Journal, the study did not disclose that Cohen is a consultant to three pharmaceutical companies and a paid speaker for seven drugmakers or that some of his research is funded by four such companies. The second listed author of the study -- Lori Altshuler, director of the Mood Disorders Research Program at the University of California-Los Angeles -- is a consultant or speaker for at least five drug companies, affiliations that were not disclosed. Adele Viguera, associate director of MGH's perinatal psychiatry program and co-author of the study, did not disclose that she is a member of GlaxoSmithKline's speakers bureau. The study did disclose the financial ties to drug companies of two of the authors, Zachary Stowe and Jeffrey Newport of Emory University.

Previous Studies
The study is the first major research paper to establish a relapse risk for pregnant women who stop taking antidepressants, the Journal reports. Previous studies have questioned the safety of antidepressant use during pregnancy. One study found an increased risk of an infant experiencing a potentially fatal lung disorder if the woman takes a group of antidepressants called selective serotonin reuptake inhibitors during pregnancy, and two other studies found that use of GSK's Paxil during pregnancy could cause cardiac fetal heart defects. The results of those studies are being called into question by industry-paid experts in the field, according to the Journal.

JAMA, Authors' Reactions
JAMA said that its policy requires study authors to disclose all ties to the medical industry, the Journal reports. JAMA editor-in-chief Catherine DeAngelis said the journal was not aware of the relationships some of the study's authors had with drug companies, and "[a]s soon as JAMA found out that they didn't disclose, we contacted ... Cohen and asked for his explanation." She added, "We have one and it will be published very soon in an upcoming issue of JAMA." According to the Journal, the researchers "maintain that their financial links have no bearing on their research work or what they say about antidepressant use during pregnancy in interviews or lectures." Cohen said that "it didn't seem relevant" for him and other co-authors to disclose their financial ties in part because the study was funded by a federal health agency. He declined to describe his consulting role to drug companies or how much he is paid for the role, but he did say that drug companies "tend to pick people who are experts in this area" and "we are not talking about megabucks." Viguera said that because of the way the study was designed, he does not "see how any kind of relationship [the researchers] have with a pharmaceutical company plays a role in that." He added, "I don't believe there is a conflict of interest."

Other Reaction
According to the Journal, "industry-paid opinion leaders have become dominant authorities" in the field of antidepressant use during pregnancy, and they often assist in developing clinical guidelines, are members of journal editorial boards, provide counsel to government agencies and teach courses to other physicians. "Whether or not to keep taking an antidepressant during pregnancy is a critical question for pregnant women suffering from depression," Adam Urato, a Bradenton, Fla.-based obstetrician and perinatologist who has questioned Cohen and his colleagues about their financial ties, said, adding, "What these pregnant women and the providers who care for them need is expert advice that is free from pharmaceutical industry influence or the suggestion of bias that results when these experts are being paid by many antidepressant manufacturers." A Pfizer spokesperson said, "It is important to remember that this is a partnership with the mutual goal of advancing science and enhancing patient care." Nada Stotland, a professor of obstetrics and psychiatry at Rush Medical College in Chicago, said pharmaceutical companies have the resources needed to fill a research void on the effects of antidepressants during pregnancy, but they often "only do what they are required to do" by FDA. She added that there are few studies that examine the effects of antidepressant alternatives, such as psychotherapy, on treating depression among pregnant women. Alan Gelenberg, head of the psychiatry department of the University of Arizona and editor of the Journal of Clinical Psychiatry, said less than 5% of his income comes from consulting work with pharmaceutical companies, adding, "The problem is if you want an expert on antidepressants in pregnancy, most of us have taken some industry money." Gelenberg said the answer to industry-funded experts is increased funding from government and independent sources (Wall Street Journal, 7/11).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=47048

No More "Fast Food"

2006-07-10T14:02:00.000-07:00

Fast Food 'Has No Place' In Hospitals, Opinion Piece States

10 Jul 2006

Fast food "has no place" in hospitals and medical centers, Andrew Weil, director of the integrative medicine program at the University of Arizona College of Medicine, writes in a New York Times opinion piece. According to Weil, a 2002 study conducted by researchers at the University of Michigan found that four of 10 hospitals had on-site fast food restaurants. "Today, I'm afraid, that number can only have gone up," he adds. Weil writes that, although the "increasing availability and popularity of fast food is a major cause of obesity and declining health," efforts to remove fast food from hospitals lead to the "same tangle of inertia and apathy that has kept hospitals from serving patients appetizing and wholesome food -- and has instead allowed large corporations to put profit ahead of quality." He adds, "We must have nutritionally literate doctors," as well as the same "kind of grassroots activism that has removed sugary sodas and candy from vending machines in many schools," to remove fast food from hospitals (Weil, New York Times, 7/6).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=46725

Visit HonestMED.com

Electronic Medical Records

2006-07-07T19:48:00.000-07:00

Paper, plastic, or electronic? The revolution in medical record keeping - The typical visit to the ER to see a patient whom I have never met before usually goes something along these lines.

Me: "What medications do you take at home?"

Patient: "Ohh, I take this little green one at night and the big white one in the morning and one at night".

"Do you remember the names of these medications or the amounts?"

"Oh no my daughter gives them to me."

"Who is your doctor?"

"He is at the [local] clinic."

"What is his name?"

"I don't remember."

"Have you ever had a heart attack?"

"Last year my doctor was worried about my heart so he did this big test where he put this thing on my chest and then he said I did have a heart attack but that my heart was OK."

"Did you see a special heart doctor?"

"I don't know but I did see this other doctor who told me that I have cancer in my chest."

"What? What kind of cancer? Did you get treated?"

"Oh no because my other doctor told me that I didn't have cancer so I never went back to him."

. . . etc. etc. etc.

Of course the usual tests will still get done to evaluate this patient's symptoms but this patient's care would certainly be safer (i.e. avoiding duplicate invasive testing), better, and more efficient if I had easy and quick access to her constantly updated medical records. However, currently record keeping in the medical industry is a complete and total mess. In my experience most paper records are either inaccessible within a reasonable amount of time (sequestered in doctor's offices over the weekend or holidays or deep in a hospital's basement) incomplete, confusing, or very poorly done.

Many private physician's offices are converting over to electronic medical records (EMRs) and most hospitals already have some type of computerized recording keeping but very few of these different systems are compatible meaning that there is no way to transfer information between them. Because of such fragmentation most of these EMR systems remain useful only to physicians within that system (hospital or office practice). If patients travel between different systems to get care we are usually left with the same difficult Q&A session like the hypothetical one above.

National Health Information Technology Coordinator Dr. David J. Brailer is the point man in the Federal government's efforts to change the system. His message to the health care and information industries is simple; Agree on a system of standards and uniformity that would allow different EMRs to talk to each other or government will make the decision for you.

The approach, he said, must include a method to certify that the records can be opened and read by doctors and specialists, as authorized by the patient, even when different clinics and hospitals have different computer systems. If the industry cannot agree upon such standards by this summer, "then government will probably do what government does best - put out a mandate."

What is motivating government to push for uniform EMRs? It's possible that eRecords could save 10% or more in yearly health care spending by eliminating the need for so much duplicate testing (often needed when paper records are not available). The other assumption is that eRecords will lead to better medical care and help to eliminate medical errors (this alone is worth the price of admission).

Many barriers still remain, however. The obvious one is cost. The health care industry usually pours its investment capital into new and expensive diagnostic and treatment systems leaving very little for improved record keeping and patient tracking. Who is to pay for all these new and very expensive EMRs? You and I, that's who. Either through higher insurance premiums or taxes. With any luck the money saved by improved record keeping will more than pay for these initial costs but this is still another example of how we are going to have to pay for better medical care.

Security and privacy is another concern especially considering the HHA's HIPAA regulations. Even though HIPAA does not prohibit the electronic transmission of medical records it does set standards for the protection of files and data on a system from unauthorized access. In most cases these standards are reasonable and straightforward and not unlike what my bank does to protect my online account information. However, security concerns do hamper access (the computer system at the hospital where I practice is not currently accessible from the internet because of concerns about hacking).

I would hate to see these security concerns seriously constrict the growth of EMR systems and efforts to connect these systems using the internet and wireless communication. The pros to patient care far outweigh the cons of security and privacy concerns. While such serious crimes as identity theft, credit card fraud, and theft of funds are potential huge problems for the online banking industry consumers appear more concerned about the privacy of their electronic medical records than they do about their own financial information and credit reports which are usually potentially accessible online.

What they should be concerned about is the pathetic condition of their medical records if kept in paper form. As Harvard professor and EMR advocate Dr. Bleich stated in 1993;

"The (paper) medical record is an abomination ... it is a disgrace to the profession that created it. More often than not the chart is thick, tattered, disorganized and illegible; progress notes, consultant's notes, radiology reports and nurses notes are all co-mingled in accession sequence. The charts confuse rather than enlighten; they provide a forbidding challenge to anyone who tries to understand what is happening to the patient."

Childhood Immunizations?

2006-07-01T17:29:00.000-07:00

IMMUNIZATIONS: A Second Opinion
by Stephen C. Marini, M.S., Ph.D., D.C.
Originally Printed in: I.C.P.A. Newsletter July/August 1997

The following is an excerpt from a statement presented on June 8, 1995 in
Washington, D.C. at the Vaccine Safety Forum of the Institute of Medicine, a
branch of the Center for Disease Control (CDC).

There is historic epidemiologic evidence that the incidence and severity of
infectious diseases wanes in populations over time, particularly in
technologically advanced countries such as the United States, as the human
immune system naturally adapts to the challenge.

Especially with regard to the passing on of maternal antibodies to protect
newborns and keeping usually mild childhood diseases, such as rubella and
chicken pox, out of adult populations where they are more severe, the
advantage of permanent immunity gained from natural recovery from infectious
disease as children outweighs the artificial, temporary immunity provided by
vaccines. Data also suggest that the diseases of childhood are necessary for
appropriate development, maturation and function of the individual immune
and nervous systems.

Furthermore, progress in the field of Psychoneuroendocrinimmunology has led
some researchers to conclude that vaccines in general may not only be
impacting negatively on the human immune system, but may also be adversely
affecting the neurologic and psychologic development and function of the
vaccine recipient. The impact of artificial immunity on immune, neurologic,
endocrine, and psychologic systems has not been scientifically elucidated.

There is no credible scientific data to demonstrate that the injection of
multiple antigens simultaneously into a baby, particularly a baby under the
age of one year, is safe and effective. There is no credible scientific
evidence to negate the hypothesis that vaccines cause immediate or delayed
damage to the immune and neurological disorders including asthma, learning
disabilities, hyperactivity, autism, chronic fatigue syndrome, lupus,
diabetes, epilepsy, multiple sclerosis, Guillain-Barre syndrome, and other
diseases. There is no assurance that the agency charged with detailing and
reporting adverse events following immunizations is not ethically
constrained by its conflicting responsibility of promoting a vaccine.....

There is growing public awareness of the significance of alternative
measures, such as proper nutrition, exercise, rest positive mental outlook
and the maintaining of neurologic integrity, as powerful instruments for
immunologic enhancement and defense against disease. There is increasing
recognition among health care practitioners that the human body has an
innate ability to protect and heal itself when allowed to function optimally
without interference.
Educational Conduits which target the largest number and widest
socio-economic cross-sections of the public should be used to reinforce the
concept that wellness is a way of life and can only be achieved by employing
preventive health care strategies which enhance, not suppress or interfere
with, the natural functioning of the human immune system. In recognition of
the need to enhance the innate human immune capacity to resist infectious
diseases such as polio, health and wellness advocates of the 21st century
support the SANS or NO VACCINE option.

Stephen Marini, M.S., Ph.D., D.C. , member of the ICPA Board of Directors,
author of numerous articles on virology and vaccination, prominent speaker
for the ICPA Chiropractic Pediatric Certification program, former
Immunohematologist //Senior Medical Technologist, currently enjoying a
successful chiropractic practice in King of Prussia, PA. Dr. Marini will be
a featured speaker for the National Vaccine Information Center's First
International Public Conference on Vaccination September 13-15 in
Alexandria, VA.

KETEK Label to have warning

2006-06-29T14:16:00.000-07:00

Antibiotic label to warn of liver danger

The label of an antibiotic will be updated to reflect reports of severe liver problems, including several deaths, its manufacturer said Thursday.

Sanofi-Aventis said the antibiotic, Ketek, will carry a bold-type warning about reports of liver failure and severe injury, some of them fatal, in patients treated with the drug. The company also will provide additional information to patients and doctors.

Sanofi-Aventis believes the drug's benefits still outweigh its risks.

The Food and Drug Administration has received reports of 12 cases of acute liver failure, including four deaths, in patients treated with Ketek, according to an internal agency memo.

FDA safety evaluators also uncovered 23 other cases where patients suffered serious liver injuries after receiving the antibiotic, also called telithromycin. The reports, when considered in proportion to the number of prescriptions filled for Ketek, exceed what's been seen in similar antibiotics, according to the memo.

The Senate Finance Committee is investigating allegations of fraud connected with trials of Ketek.

Earlier this month, Sanofi-Aventis stopped enrolling children in trials of the drug. The company has sold Ketek in the United States since 2004.

Stem Cell News

2006-06-27T21:11:00.000-07:00

Stem Cell Receptors May Fight Autoimmune Diseases

12 minutes ago

TUESDAY, June 27 (HealthDay News) -- New information about the role of bone marrow stem cells could lead to important advances in treating diseases like leukemia, lupus and rheumatoid arthritis, scientists say.

Researchers at the Oklahoma Medical Research Foundation in Oklahoma City, in collaboration with the University of Tokyo, Osaka University and Saga University of Japan, studied the purified bone marrow stem cells of laboratory mice. They discovered that these cells -- once thought to be essentially dormant -- can identify the presence of bacteria and viruses in the blood.

"We have long known that so-called hematopoietic (blood) stem cells create the blood cells that are the front-line soldiers in the body's immune system," study author and foundation researcher Paul Kincade said in a prepared statement. "But we did not believe that infectious agents played an active role in the process," he added.

Once the infectious agents have been identified, the stem cells begin defending the body against these foreign pathogens -- a fact that surprised the scientists.

"What we have now discovered is that these stem cells have a sort of antennae that detect bacteria and viruses," said Kincade. "And when stem cells receive these distress signals, they spring to action, creating cells the body most needs early in life-threatening situations," he said.

That could mean very good news for patients with autoimmune diseases. Understanding the role of these stem cells means that scientists one day may be able to figure out how to manipulate these stem cells to benefit such patients.

"It may be possible to boost immunity when necessary and also shut down inappropriate responses. That could provide a powerful tool to fight cancer, lupus and many other diseases," Kincade said.

The findings appear in the June issue of the journal Immunity.

More information

Johns Hopkins Medical Institutions have more information on autoimmune diseases.

Heartburn?

2006-06-26T11:00:00.000-07:00

Heartburn More Common in Western Countries By Jennifer Warren, MD
WebMD Medical News Reviewed By Louise Chang, MD
on Thursday, June 22, 2006

June 22, 2006 -- One in four people in Western countries suffer from heartburnheartburn at least once a month, according to a new study that shows the problem is much more common in the West than in other parts of the world.

Researchers found that 25% of people in Western countries report symptoms of heartburn at least once a month; 12% suffer from the burning and pain in the chest at least once a week.

In contrast, only 11% of those living in Eastern Asian countries report having heartburn at least once a month and 4% weekly.

Feeling heartburn can occur when the acidic contents of the stomach back up into the esophagus, resulting in a feeling of burning or pain in the chest or upper abdomen. It is also a symptom of gastroesophageal reflux disease (GERDGERD).

--------------------------------------------------------------------------------
Sleeping With Heartburn Carries Cancer Risks
--------------------------------------------------------------------------------

East vs. West

In the study, published in this week's issue of The Lancet, Nicholas Talley, MD, and colleagues at the Mayo Clinic in Rochester, Minn. looked at the prevalence of heartburn reported in 31 studies on the topic.

Their analysis showed that more people in Western countries report frequent heartburn compared to those in other areas, In fact, 5% in the West report symptoms every day, compared to 2% in Eastern Asian countries.

Although the cause of heartburn is unknown, genetic factors are thought to play a role. ObesityObesity and lifestyle factors such as eating certain foods, drinking alcohol, and smoking increase the risk of developing heartburn.

Researchers put the cost of managing and treating heartburn and GERD in the U.S. at more than $9 billion.

--------------------------------------------------------------------------------

SOURCES: Moayyedi, P. The Lancet, June 24, 2006; vol 367; pp 2086-2100. News release, The Lancet.

Medical Tests -- Self Service

2006-06-22T21:27:00.000-07:00

Several Web Sites Offer Access To Diagnostic Tests

22 Jun 2006

Several Web sites -- DirectLabs.com, HealthCheckUSA, MedlabUSA.com and MyMedLab.com -- are offering consumers the chance to order the same diagnostic tests they might obtain at walk-in laboratories, hospitals and clinics, the Wall Street Journal reports. Customers do not need a prescription from their physician to obtain the tests; rather, they can visit one of the Web sites, choose a test, enter their ZIP code and receive driving directions to the nearest laboratory. According to the Web sites, an in-house doctor approves requests for the tests. Patients pay upfront for the tests and can receive a receipt to submit for reimbursement from an insurance company or a health savings account. However, most insurance companies will not reimburse patients for tests that were not ordered by a physician, the Journal reports. A blood test from MyMedLab.com costs $45, while a local hospital lab test costs $295. Customers can get screenings for heart disease, diabetes, sexually transmitted infections and iron levels. Results are only reported to the customer, and they are not included in a patient's medical records. According to the Journal, typical users of the online services are "health-conscious people who want tests to monitor" various conditions and "uninsured people who don't want to pay for regular doctors visits." The sites also target patients concerned about confidentiality. Bruce Friedman, emeritus professor of pathology at the University of Michigan Medical School, said, "Anything that can get people to a higher level of awareness of their own health status and get them to take some ownership is positive." David Clymer, president of MyMedLab.com, said, "We're not simply 20% cheaper -- we're 20% of [hospitals' cost]. That's how consumer-driver health care is supposed to be." However, some doctors fear that users will "misinterpret or ignore" their test results, the Journal reports. Edward Hill, a family physician and past president of the American Medical Association, said, "Do [patients] know what to do with the results?"(Timiraos, Wall Street Journal, 6/20).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=45594

Improper Practices Charge Thrown Out

2006-06-22T11:59:00.000-07:00

Judge Throws Out Charges Against UnitedHealthcare, Coventry Of Improper Practices In Paying Physicians

22 Jun 2006

U.S. District Judge Federico Moreno on Monday dismissed all claims that remained against UnitedHealth Group and Coventry Health Care in a class-action lawsuit filed on behalf of more than 700,000 physicians nationwide, the Wall Street Journal reports (Fuhrmans, Wall Street Journal, 6/20). In the lawsuit, filed in the U.S. District Court for the Southern District of Florida in 1999, physicians alleged that Aetna, Anthem Blue Cross and Blue Shield, Cigna, Coventry Health Care, Health Net, Humana, PacifiCare Health Systems, Prudential Financial Securities, UnitedHealth and WellPoint Health Networks delayed or denied reimbursements for medical services and illegally rejected claims for necessary services as part of a racketeering conspiracy (Kaiser Daily Health Policy Report, 10/19/05). The other health insurers involved in the lawsuit had previously settled claims against them for a combined $646 million. In his decision, Moreno wrote, "After reviewing thousands of documents, there is simply insufficient evidence of the wrongdoing claimed." He added that, although he did not support the actions of UnitedHealth and Coventry, those actions were "beyond the power of this court." In addition, Moreno wrote, "Those desiring changes in the way health care is provided in America must either look for remedies before Congress or allow the free market to dictate the results."

Reaction
Harley Tropin, co-lead attorney for the physicians, said, "We are extremely disappointed and respectfully disagree with the court's order." He added that the plaintiffs might appeal the decision (Dorschner, Miami Herald, 6/20). Archie Lamb, co-lead attorney for the physicians, also said that UnitedHealth and Coventry could face additional lawsuits related to reimbursement practices because they did not settle the claims against them (Wall Street Journal, 6/20). In a statement, UnitedHealth CEO William McGuire said, "We are pleased with today's decision. Looking ahead, UnitedHealth Group will continue to focus on our overarching goal: working constructively with physicians and other partners to provide all Americans with greater access to affordable, quality health care" (Miami Herald, 6/20).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=

Stem Cell Research

2006-06-20T09:21:00.000-07:00

New Stem-cell Findings Can Help The Body To Cure Itself

20 Jun 2006

Researchers at Karolinska Institutet have identified an important mechanism that regulates how many new cells are produced by each intestinal stem cell. The study is published in the latest issue of the prestigious scientific journal, Cell. "This might eventually help us develop new drugs for things like neurological disorders and anaemia," says Professor Jonas Frisen.

In most organs of the body, old cells are continually being replaced by new. If too many new cells are produced, however, it can lead to overgrowth and tumour formation. Too few cells, on the other hand, can result in organ degeneration. It is therefore crucial that exactly the right number of cells are produced.

As many serious disorders cause a reduction in the production of new cells, scientists are keen to develop drugs that stimulate the process, which in turn could help the body to cure itself.

It has long been known that the new cells are often formed by immature cells known as stem cells, but the mechanism regulating the number of new cells produced has remained something of a mystery. However, in a new study to be published by Cell stem-cell researcher Jonas Frisen has succeeded in showing how the body's own stem cells do just this. Working alongside an American group of researchers, Professor Frisen and his team have identified a signal transduction process that regulates the degree of stem-cell division.

"Understanding how cell production is regulated increases our chances of producing drugs able to stimulate the endogenous production of new cells," says Professor Frisen.

He hopes that the new findings can be used to develop drugs that stimulate, for example, the formation of new nerve cells to treat conditions such as stroke and Parkinson's and skin cells to facilitate the healing of wounds. Professor Frisen is best known for his research on cerebral stem cells; the present study, however, has been carried out on stem cells in the intestine, one of the organs in the body with the highest rates of cell renewal.

"We also know that blood, brain and skin stem cells express the genes that we now know to be important in the intestine," he says. "This suggests that the cell production mechanism can be the same for these stem cells too."

The next step for Professor Frisen and his group is therefore to study how blood and skin stem cells go about producing new cells.

###

Publication:

"EphB receptors coordinate migration and proliferation in the intestinal stem cell niche" by Johan Holmberg, Maria Genander, Michael M. Halford, Cecilia Anneren, Mariann Sondell, Michael J. Chumley, Robert A. Silvany, Mark Henkemeyer and Jonas Frisen Cell, June 2006
For more information, please contact:

Professor Jonas Frisen at mailto:jonas.frisen@ki.se
Katarina Sternudd, press officer, at mailto:katarina.sternudd@ki.se

Contact: Press Officer Katarina Sternudd

Karolinska Institutet

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=45427

Halt on Drug Ads

2006-06-15T14:10:00.000-07:00

AMA Wants Halt on Drug Ads Aimed at Consumers

By Steven Reinberg
HealthDay Reporter 56 minutes ago

THURSDAY, June 15 (HealthDay News) -- In an effort to make prescription-drug ads aimed at consumers more understandable and informative, the American Medical Association is calling for a temporary halt on advertising for newly approved drugs.

The AMA is also calling for guidelines for future ads, which would be subject to approval by the U.S. Food and Drug Administration before they appeared.

At its just-concluded annual House of Delegates meeting in Chicago, the AMA endorsed a policy asking for a temporary moratorium on so-called direct-to-consumer (DTC) advertising of new prescription drugs and implantable medical devices.

"A temporary moratorium on DTC advertising of prescribed drugs and medical devices will benefit both the patient and physician," AMA President-elect Dr. Ronald M. Davis said in a prepared statement. "Physicians will have the opportunity to become better educated on the pros and cons of prescription drug uses before prescribing them, and will be better able to determine when they are best suited for their patients' medical needs."

Medical devices were added to the proposal because many doctors who spoke at the AMA meeting said direct-to-consumer ads for medical devices were already appearing, Davis told HealthDay. "This is happening in such fields as orthopedics," he said.

The association plans to ask the FDA to enact the policy, so the length of any moratorium would be determined by the drug agency. "If you have a drug which is critical to the treatment of a particular disease for which alternate treatments are not available, that would push to limiting the length of the moratorium," Davis said.

The AMA also endorsed new guidelines for advertising prescription drugs to consumers. The guidelines call for providing objective information about the benefits and risks of a drug as determined in clinical trials. They also urge more research into the effects of direct-to-consumer advertising on "the patient-physician relationship, overall health outcomes and health-care costs."

The doctors' group also wants the FDA to approve all direct-to-consumer ads before they appear. "We crafted our proposal to provide for very tight FDA authority over DTC ads," Davis said.

In addition, ads should allow enough time or space for consumers to understand all the warnings, precautions and potential side effects, without being distracted by other content in the advertisement, the doctors' group said.

The ads should also refer patients to their doctors for a full explanation of a drug and its use, and be targeted to age-appropriate audiences, the guidelines state.

The Pharmaceutical Research and Manufacturers of America said it generally supports the AMA's position. But the drug industry group believes its own voluntary monitoring program is sufficient to deal with the content of direct-to-consumer ads.

"PhRMA appreciates and supports the American Medical Association's continuing efforts to improve patient education and to provide quality information on health conditions and the treatment options available to conquer disease," Dr. Paul Antony, chief medical officer for the group, said in a prepared statement. "Informed patients are better patients and DTC advertising provides doctors and patients with accurate, educational information about disease and treatment options."

"PhRMA and its member companies announced last year its voluntary Guiding Principles on Direct-to-Consumer Advertisements About Prescription Medicines in an effort to further enhance the educational value of prescription drug advertising," Antony added. "While there are subtle differences between the Guiding Principles and the AMA's report, both emphasize the critical need to educate physicians and other health-care providers about a new medicine before it is advertised to the public."

Dr. Peter Lurie, deputy director of consumer advocacy group Public Citizen's Health Research Group, thinks the AMA proposal doesn't go far enough to guarantee complete information on prescription drugs to the public.

"The AMA suggestion is fine but it is nonspecific," said Lurie, adding there's no mention of how many years the moratorium would be in effect. "All that is up in the air, and there is no reason why that can't be made more specific," he said.

The most important part of the proposal calls for the FDA to prescreening ads, Lurie said. "If prescreening really happened that would be a big help," he said.

"The real solution to the problem of lack of patient information is not to leave it to the market, where self-interested people advertise only those products on which they can make a buck," Lurie said. "The real solution is to provide patients with government-sanctioned information on each and every drug."

Another consumer advocate doesn't think the AMA proposal would do anything to protect the public.

"Direct-to-consumer drug ads are dangerous and should be illegal," said Gary Ruskin, executive director of the consumer watchdog group Commercial Alert. "The AMA's policy is so weak that it will do little, if anything, to protect public health. It won't make much of a difference at all."

The AMA's Davis said his group considered a ban on direct-to-consumer ads but opted for FDA oversight instead. "There are some potential benefits from DTC advertising," he said. "In particular, educating the public about the availably of new medications and prompting discussions between patients and physicians about new medications."

But there are some risks, Davis added. "Such as building up false expectations among patients about what these drugs may or may not do, or whether they are appropriate for the disease or condition that a patient has," he said. "Laying out the advantages and disadvantages of DTC ads and the benefits and harms, we came down on the side of tight FDA oversight over DTC ads as opposed to a total ban," he said.

More information

To learn more about direct-to-consumer ads, visit the U.S. Federal Trade Commission

Ketek Killer

2006-06-15T08:28:00.000-07:00


US FDA Denies Sen Grassley Access To Ketek Investigator
06-14-06 06:55 PM EST WASHINGTON (AP)--Federal health officials on Wednesday rebuffed a U.S. lawmaker's attempt to meet with a Food and Drug Administration special agent who is investigating an antibiotic linked to a dozen reports of liver failure, including several deaths. Sen. Chuck Grassley, R-Iowa, said Health and Human Services Department officials denied him access to the agent. Grassley later said he may convene a Senate Finance Committee hearing as part of that staff's ongoing investigation into allegations of fraud connected with trials of the drug, Ketek. "I smell a cover-up," said Grassley, who is chairman of the committee. Allowing the agent to speak to Grassley would have violated policy and compromised that agent's work, FDA spokeswoman Susan Bro said. "Imposing inquiries on an investigator during the process and or releasing documents involved with an open investigation could essentially provide a roadmap of our ongoing work and seriously undermine the investigation," Bro said. The FDA has received reports of 12 cases of acute liver failure, including four deaths, in patients treated with Ketek, according to an internal FDA memo. Sanofi-Aventis SA (SNY) makes the drug, which the FDA approved in 2004. The company has said it believes Ketek is safe and effective when used as directed. If warranted, the FDA would consider strengthening warnings on the drug's label, Bro said. The FDA-approved label for Ketek warns of liver disfunction that can be severe but is "usually reversible."

Emergency Rooms Not Available?

2006-06-14T20:04:00.000-07:00

WASHINGTON Jun 14, 2006 (AP)— Half a million times a year about once every minute an ambulance carrying a sick patient is turned away from a full emergency room and sent to another one farther away. It's a sobering symptom of how the nation's emergency-care system is overcrowded and overwhelmed, "at its breaking point," concludes a major investigation by the influential Institute of Medicine.

That crisis comes from just day-to-day emergencies. Emergency rooms are far from ready to handle the mass casualties that a bird flu epidemic or terrorist strike would bring, the institute warned Wednesday in a three-volume report.

"If you can barely get through the night's 911 calls, how on earth can you handle a disaster?" asked report co-author Dr. Arthur Kellerman, Emory University's emergency medicine chief.

That ERs are overburdened isn't new. But the probe by the IOM, an independent scientific group that advises the government, provides an unprecedented look at the scope of the problems and recommends urgent steps for health organizations and local and federal officials to start fixing it.

Topping that list is a call for coordinating care so that ambulances don't waste potentially lifesaving minutes wandering from hospital to hospital in search of an ER with room. The idea is to set up regionalized systems that manage the flow much like airports direct flight traffic. That also should direct patients not just to the nearest ER but to the one best equipped to treat their particular condition making sure stroke victims go to stroke centers, for example.

Other recommendations:

Congress should establish a pool of $50 million to reimburse hospitals for the unpaid emergency care they provide to the poor and uninsured.

Congress should ensure that more of the nation's disaster-preparedness funding goes to the hospitals and emergency workers who will provide that care. Typical government grants to hospitals for bioterrorism preparation are $5,000 to $10,000 not enough to equip one critical-care room. When it comes to getting ready for a bird flu outbreak, few hospitals even have the ventilation equipment needed to isolate patients. And emergency medical services received only 4 percent of the $3 billion distributed by the Department of Homeland Security in 2002 and 2003 for emergency preparedness.

The board that accredits the nation's hospitals should establish strong guidelines to reduce crowding and ambulance diversion.

At the root of the problem: Demand for emergency care is surging, even as the capacity for hospitals, ambulance services and other emergency workers to provide it is dropping.

There were almost 114 million emergency room visits in 2003, up from 90 million a decade earlier. During the same time, the total number of U.S. hospitals decreased by 703, and the number of ERs by 425. And the total number of hospital beds nationwide dropped by 198,000, as hospitals strive toward more outpatient care which in turn leaves fewer beds for ER patients to move into when they're seriously ill.

Too often, busy ERs stabilize those patients and then have to leave them lying on gurneys in the hallway for 48 hours or more until a room becomes available and they can be admitted to the hospital. That's not only a time of misery for the patient, but it means less timely care and potentially poorer care, without the specialized equipment and expertise available to inpatients, the report found.

Children have even scarcer help. They make up more than a quarter of all ER visits, yet one survey found only 6 percent of emergency departments had all the supplies needed, such as child-size equipment, to treat them.

Before getting to the hospital, the EMS system emergency medical services that include ambulances and paramedics is fragmented. How well-trained and prompt local paramedics are varies greatly; there are no nationwide standards. Many ambulance services can't even effectively communicate with hospitals or other first responders because of antiquated equipment.

The American College of Emergency Physicians called the report groundbreaking but said Congress must heed recommendations to fund the necessary improvements.

"Open" Posting to this blog

2006-06-14T13:00:00.000-07:00

This is an "open" blog, meaning that anyone can post by email to:
POST
and your posts will go directly onto the blog. Of course, if they are obscene or off-topic, they will be removed, but we want to encourage all visitors to participate and to visit our website honestmed.com

Alzheimer News

2006-06-14T11:51:00.000-07:00

A Sweet Solution for Alzheimer's Disease?
Libraries
Medical News Keywords
ALZHEIMER'S DISEASE ST GEORGE-HYSLOP INOSITOL SCYLLO-INOSITOL AMYLOID
BETA CLINICAL TRIALS NEUROBIOLOGY
Contact Information

Available for logged-in reporters only
Description

Certain variants of a simple sugar ameliorate Alzheimer's-like disease
in mice, according to a new study by Canadian researchers. Although the
studies are still in the early stages, the findings could lead to new
therapies that prevent or delay the onset of Alzheimer's disease.

Newswise - Certain variants of a simple sugar ameliorate
Alzheimer's-like disease in mice, according to a new study by Canadian
researchers. Although the new studies are still in the early stages,
the findings could lead to new therapies that prevent or delay the
onset of Alzheimer's disease.

The new studies show that some types of a sugar called
cyclohexanehexol-also known as inositol-prevented the accumulation
of amyloid ? deposits, a hallmark of Alzheimer's disease.
Scyllo-inositol treatment also improved cognitive abilities in the mice
and allowed them to live a normal lifetime. The study appeared in
advance online publication of the journal Nature Medicine on June 11,
2006.

HHMI international research scholar and senior author Peter St
George-Hyslop cautioned that the chemicals tested in these studies are
not the type of inositol sold commercially as a nutritional supplement.
That type-myo-inositol-has been shown previously to be ineffective
at breaking up amyloid aggregates, he said.

In the brain of a person with Alzheimer's disease, small proteins
called amyloid ? aggregate into plaques, and a protein called tau
clumps into neurofibrillary tangles. The brain becomes inflamed and
neurons atrophy and die. It's not completely clear what kind of amyloid
? peptide (monomers, oligomeric aggregates, or fibrillar aggregates) is
responsible for the onset of disease, said St George-Hyslop of the
University of Toronto. "Because we were able to show that
scyllo-inositol specifically dispersed the high-molecular-weight
oligomeric aggregates, this study confirms that the initiating event is
the accumulation of oligomeric aggregates of amyloid ? peptide," he
said.

Previous work by JoAnne McLaurin, also of the University of Toronto and
lead author of the Nature Medicine paper, showed that several types of
inositol could stop amyloid proteins from aggregating in test tubes. To
see if these compounds could do the same in living animals, St
George-Hyslop, McLaurin, and colleagues tested them in transgenic mice
with human genes that predispose them to an Alzheimer's-like disease.

When the researchers treated these mice with scyllo-inositol, all of
the animals' disease symptoms improved. Cognitive function was
improved, amyloid plaques disappeared, inflammation declined, and the
mice lived longer.

The scientists found that scyllo-inositol conferred these benefits not
only if the mice were treated when they were very young and
disease-free, but also if they were treated after the onset of disease.

As a model system, these mice "are pretty good, but they're not a
perfect replica of the disease," St George-Hyslop said. The mice do
not develop tau tangles, he explained, but they are prone to amyloid
plaques, brain inflammation, cognitive disturbance, and early death,
just like humans with Alzheimer's disease.

The researchers found that the scyllo-inositol worked better than the
epi-inositol version. Scyllo-inositol produced more dramatic benefits
overall, while epi-inositol worked only transiently and only when given
before disease symptoms appeared.

Scyllo-inositol "is an exciting experimental therapy, but until it
has actually been tested in humans, it should not be considered the
cure for Alzheimer's disease," St George-Hyslop said. "There are
many things that are very promising when done in animal models that
turn out to either not work in humans or to have unexpected
toxicity."

A public Canadian company called Transition Therapeutics has regulatory
approval for clinical trials of scyllo-inositol in humans with
Alzheimer's disease and started them about a week ago. St George-Hyslop
has a small financial interest in the company.

St George-Hyslop and his colleagues are optimistic that scyllo-inositol
will be less toxic to humans than some previous drug candidates for
Alzheimer's disease. A vaccine designed to destroy amyloid ?, for
example, was first tested successfully in the same type of mice used in
the scyllo-inositol studies, but the vaccine turned out to be toxic in
some humans. It caused an autoimmune reaction in about 10 percent of
patients who were immunized, St George-Hyslop said.

Autoimmune responses shouldn't be a problem with scyllo-inositol.
"This compound works by a different mechanism and doesn't involve
immunizing a patient with his own protein, which was probably the
origin of the allergic reaction to the vaccine," the researcher said.

Another complication with previous attempts to treat Alzheimer's
disease has been that some compounds-such as beta secretase
inhibitors-cannot enter the brain easily, St George-Hyslop explained.
Scyllo-inositol, on the other hand, readily passes through the
blood-brain barrier where it is made available to the central nervous
system.

Even if scyllo-inositol does prove safe and effective in humans,
patients will likely still need drugs designed to attack other aspects
of Alzheimer's pathology, such as tau neurofibrillary tangles, St
George-Hyslop said.

"Alzheimer's disease is probably going to be treated by a cocktail of
drugs," he predicted. "Some of them might be this compound, or one
like it, that blocks the toxicity and aggregation of amyloid."

--------------------------------------------------------------------------------

Tainted Drugs

2006-06-14T10:27:00.000-07:00

Medical Corruption: Bayer sold HIV tainted meds to Asian countries

http://www.hinduvoice.net

[ From: Jagannath Chatterjee
[ Date: Sun, 11 Jun 2006

Dear Members,

I have been warning against the use of serum based
vaccines and medicines. These products are almost always
contaminated and carry the risk of spreading dangerous
diseases. Medical insiders know that uncontaminated serum
is a contradiction in terms. Serum can only be
"relatively pure", whatever that means. The risk of
genetic contamination is 100% as we do not screen the
serum for defective genes.

Now we have a very large drug MNC showing no regrets
about passing on HIV to patients in Asia through a serum
based medication.

Regards,
Jagannath.

June 10, 2006

http://www.cbsnews.com/stories/2003/05/22/health/main555154.shtml

Bayer Sold HIV-Risky Meds

By David McHugh
The Associated Press

FRANKFURT, Germany, May 22, 2003

(AP)

Quote

"Decisions made nearly two decades ago were based on the
best scientific information of the time and were
consistent with the regulations in place. They cannot be
judged on the information available today." Bayer AG

(AP) Chemical and drug maker Bayer AG said Thursday it
acted "responsibly, ethically and humanely" during the
1980s in selling a blood-clotting product that stopped
potentially fatal bleeding in hemophiliacs but was linked
to the risk of HIV infection.

The company's statement was in response to a New York
Times report that it sold millions of dollars worth of an
older version of the medication in Latin America and Asia
while marketing a newer, safer product in the United
States and Europe.

Bayer division Cutter Biological continued selling old
stocks of the medicine for more than a year after it
introduced a version in February 1984 that was heat-
treated to kill HIV, according to documents obtained by
the Times.

The medicine, called Factor VIII concentrate, can stop or
prevent potentially fatal bleeding in people with
hemophilia, a genetic condition that prevents blood from
clotting normally.

Early in the AIDS epidemic, the medicine was made using
plasma from 10,000 or more donors. There was not yet a
screening test for HIV, the virus that causes AIDS, so
even a small number of HIV-positive donors could taint a
large pool of plasma recipients.

As a result, thousands of hemophiliacs became infected
with HIV. Bayer and three other companies that made the
concentrate have paid about $600 million to settle more
than 15 years of lawsuits accusing them of making a
dangerous product, the newspaper said.

The Times said at least 100 hemophiliacs in Hong Kong and
Taiwan alone contracted AIDS after using the older
product, and that many have since died. Li Wei-chun said
her son, who died in 1996 at the age of 23, was among the
victims.

"They did not care about the lives in Asia," she said.
"It was racial discrimination."

Cutter also sold the older medicine in Argentina,
Indonesia, Japan, Malaysia, and Singapore after February
1984, according to the documents. The newspaper said
Cutter shipped more than 100,000 vials of unheated
concentrate, worth more than $4 million, after it began
selling the safer product.

The sales continued partly because of Cutter's desire to
deplete stocks of the older medicine, and partly because
of fixed-price contracts, for which the company believed
the older product would be cheaper to make, the newspaper
said.

In March 1983, the federal Centers for Disease Control
warned that blood products appeared responsible for AIDS
among hemophiliacs. Three months later, Cutter sent a
letter to distributors in nearly two dozen nations saying
that AIDS was "the center of irrational response in many
countries."

In late 1984, as Hong Kong hemophiliacs began testing
positive for HIV, some doctors wondered whether Cutter
was sending "AIDS-tainted" medicine into less-developed
nations.

But the company assured its distributor that the unheated
product posed "no severe hazard" and was the "same fine
product we have supplied for years."

In May 1985, Dr. Harry M. Meyer Jr., the Food and Drug
Administration's blood-products official, called the
companies to a meeting, believing they had broken an
agreement to stop selling the older medicine, the Times
said. But Meyer decided to handle the matter quietly
instead of notifying the public, the newspaper said.

ALLERGIES?

2006-06-14T09:43:00.000-07:00

Allergies:
Food Allergies

A food allergy occurs when your immune system responds defensively to a specific food protein that is not harmful to the body.

The first time you eat the offending food, your immune system responds by creating specific disease-fighting antibodies (called immunoglobulin E or IgE). When you eat the food again, the IgE antibodies spring into action, releasing large amounts of histamine in an effort to expel the "foreign invader" from your body. Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system.

What Are the Symptoms of a Food Allergy?

Symptoms may appear almost immediately, or up to two hours after you've eaten the food. Symptoms can include a tingling sensation of the mouth, swelling of the tongue and throat, hives, skin rashes, vomiting, abdominal cramps, difficulty breathing, diarrhea, a drop in blood pressure, or even a loss of consciousness. Severe reactions -- called anaphylaxis -- can result in death.

Which Foods Most Often Cause Allergic Reactions?

There are six foods that cause over 90% of food allergies - milk, eggs, peanuts, wheat, soy, and tree nuts (such as walnuts, pecans and almonds).

How Are Food Allergies Diagnosed?

Your doctor may do a radioallergosorbent blood test (RAST) to check the number of antibodies produced by your immune system. Elevated levels of certain types of antibodies can help your doctor identify specific food allergies.

The doctor may also perform an allergy skin test, also called a scratch test, to identify the substances that are causing your allergy symptoms.

By keeping a food diary, your doctor will have a much better starting point to determine the foods that could trigger your allergies. You may be asked to eliminate all potentially allergenic foods and then add them back to your diet one at a time to see if they prompt any reaction. This is called an "elimination and challenge diet."

How Are Food Allergies Treated?

The best way to cope with a food allergy is to strictly avoid the foods that cause a reaction. Mild reactions often will subside without treatment. For rashes, skin creams may ease discomfort while antihistamines can help reduce itching and other symptoms.

For more serious reactions, corticosteroids such as prednisone will help to reduce swelling. In life-threatening situations, an epinephrine injection can immediately begin to reverse symptoms and is the only effective treatment option.

How Can I Be Prepared?

Once you and your doctor have determined which foods you should avoid, stay away from them. However, it is important that you maintain a healthy, nutritious diet. Ask your doctor to recommend foods that will provide you with the necessary nutrients.

You should also be aware of the ingredients in processed foods. Be sure to read labels. A registered dietitian can help you learn how to read food labels to discover hidden sources of food allergens.

If you are prone to allergic reactions, ask your doctor to prescribe an epinephrine injection kit and carry it with you at all times.

Next: Hay Fever

View the full table of contents for the Allergy Guide.

Reviewed by the doctors at The Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine.

Edited by Cynthia Haines, MD, WebMD, March 2006.

SOURCE: The Food Allergy and Anapylaxis Network

HOSPITALS CUT LETHAL ERRORS

2006-06-14T08:38:00.000-07:00

Hospitals cut lethal errors rate

By MIKE STOBBE, Associated Press Writer 6 minutes ago

U.S. hospitals have saved an estimated 122,300 lives in the last 18 months through a massive campaign to reduce lethal errors, the leader of the national effort said Wednesday.

"I think this campaign signals no less than a new standard of health care in America," said Dr. Donald Berwick, a Harvard professor who organized the campaign.

About 3,100 hospitals participated in the project, sharing mortality data and carrying out study-tested procedures that prevent infections and mistakes. Experts say the cooperative effort was unusual for a competitive industry that traditionally doesn't like to publicly focus on patient-killing problems.

"We in health care have never seen or experienced anything like this," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations.

Berwick announced the campaign's results Wednesday morning at a hospital conference in Atlanta. O'Leary was one of hundreds of industry dignitaries and representatives in attendance.

Medical mistakes were the focus of a widely noted 1999 national report that estimated 44,000 to 98,000 Americans die each year as a result of errors and low-quality care.

That year, Berwick president of the Institute for Healthcare Improvement, a Massachusetts-based nonprofit organization challenged health care leaders to improve care quality and prevent mistakes.

In December 2004, he stepped up the challenge by announcing a "100,000 Lives Campaign." He set a June 14, 2006, deadline to sign up at least 2,000 U.S. hospitals in the effort and implement six types of changes.

Perhaps the best known of the six changes was to deploy rapid response teams for emergency care of patients whose vital signs suddenly deteriorate.

Hospitals generally have teams that respond when patients develop sudden heart or breathing problems. That work is common in emergency departments. The measure was designed to make sure the service is available around-the-clock to other units, and to encourage lower-ranking medical staff members not to be intimidated about calling for help.

Another urged checks and rechecks of patient medications to protect against drug errors. A third focused on preventing surgical site infections by following certain guidelines, including giving patients antibiotics before their operations.

The hospitals also were asked to contribute monthly mortality data to Berwick's organization, which attempted to track the impact.

The effort was endorsed by federal health officials, health insurers, hospital industry leaders, the American Medical Association and others. About 3,100 hospitals signed up, representing about 75 percent of the nation's acute care beds.

About 86 percent sent in mortality data. Roughly a third said they were implementing all six measures, and more than half committed to at least three, Berwick said.

Campaign workers examined 2004 data for the participating hospitals to determine how many people were expected to die during the 18 months of the campaign.

They then checked the count of actual deaths reported. They also made mathematical adjustments for severity of illnesses and for volume of cases, to make a more fair comparison of the two time periods more fair. They also made estimates for participating hospitals that did not report data, Berwick said.

"This is estimation it isn't counting," he said.

Various estimates placed the number of saved lives at between 115,000 and 149,000, but the best guess was 122,342, he said.

Berwick challenged the hundreds of hospital representatives at the conference to continue to improve. He also proposed another goal all hospitals should implement all six changes by the beginning of 2007.

"Open" Blog

2006-06-09T21:15:00.000-07:00

MEDICAL MISTAKES

2006-06-08T12:43:00.000-07:00

MEDICAL MISTAKES

During 1999 mainstream institutions revealed that
one of the biggest killers in the U.S. is medical mistakes.
** The NEW YORK TIMES reported that 5% of people admitted to hospitals, or about 1.8 million people per year, in the U.S. pick up an infection while there.[1] Such infections are called "iatrogenic" -- meaning "induced by a physician," or, more loosely, "caused by medical care." Iatrogenic infections are directly responsible for 20,000 deaths among hospital patients in the U.S. each year, and they contribute to an additional 70,000 deaths, according to the federal Centers for Disease Control (CDC). The yearly dollar cost of iatrogenic infections is $4.5 billion, according to the CDC.
The rate of iatrogenic infections has increased 36% in the past 20 years[1] partly because people entering hospitals now are sicker and more vulnerable then they were 20 years ago, and partly because excessive use of antibiotics has created antibiotic-resistant killer microbes.
** A large part of the problem is health care workers who fail to wash their hands properly, the TIMES reported. "Hands are the most dangerous thing in the hospital," says Dr. Robert A. Weinstein, director of infectious diseases for the Cook County Bureau of Health Services in Chicago. A study conducted at the Duke University Medical Center found that only 17% of physicians treating patients in an intensive care unit washed their hands appropriately.[1]
An alternative to hand-washing would be use of latex gloves. Unfortunately, many health care workers view gloves as protecting themselves exclusively -- they put them on in the morning and wear them all day long, the equivalent of not washing their hands. A study of glove use at a long-term care center found that gloves were worn 82% of the time when their use was indicated, but changed appropriately only 16% of the time.
Hospitals have few incentives to monitor infection rates among their patients. "If you don't do good [infection] surveillance, you don't detect infections, which means they don't exist and you look great," says Dr. William Jarvis, chief of the Investigation and Prevention branch of the Hospital Infections Program at the CDC in Atlanta.[1]
Various remedies are being considered. One is to urge health care workers to wash their hands with waterless, alcohol-based antimicrobial hand rubs which are as effective as traditional hand-washing but faster to use and gentler than soap and water.
Another approach is to train patients to ask each health care worker who comes into their room, "Did you wash your hands?"
The "big picture" of medical mistakes is even worse. A report entitled, TO ERR IS HUMAN, issued by the National Institute of Medicine (a division of the National Academy of Sciences) in November found that medical mistakes kill somewhere between 44,000 and 98,000 people (average: 71,000) in hospitals in the U.S. each year.[2]
There are about 33.6 million people admitted to hospitals each year in the U.S. Somewhere between 2.9% and 3.7% (average: 3.3%) of these suffer an "adverse event" while in the hospital.[2,pg.1] An "adverse event" is defined as an injury caused by medical management rather than by the underlying disease or condition of the patient.[2,pg.25] Of these adverse events, somewhere between 8.8% and 13.6% (average: 11.2%) are fatal.[2,pg.1] Of all adverse events, somewhere between 53% and 58% (average: 55.5%) are attributable to mistakes.[2,pg.22] Therefore we can calculate[3] that, on average, one out of every 500 people admitted to a hospital in the U.S. is killed by mistake. (For comparison, the chance of being killed in a commercial airline accident is one per 8 million flights.) Thus medical mistakes qualify as a major public health problem. Even the low estimate, 44,000 killed by medical mistakes each year, exceeds the number of people killed in the U.S. by automobile accidents (43,458 in 1998).
For those who are accustomed to thinking in terms of 1-in-a-million as an "acceptable" death rate for technological errors, the 1-in-500 deaths by medical mistakes equates to 2000-in-a-million.
TO ERR IS HUMAN acknowledges that the 1-in-500 figure may underestimate the size of the death-by-medical-mistake problem because the 1-in-500 estimate is based on information found in patient records and many medical mistakes may not be acknowledged in patient records. TO ERR IS HUMAN says, "Most errors and safety issues go undetected and unreported, both externally and within health care organizations."[2,pg.37] "Silence surrounds this issue," the report says.[2,pg.2]
TO ERR IS HUMAN provides evidence that the 1-in-500 estimate may be low. The report describes two studies that found rates of death due to medical mistakes that far exceed 1 in 500. One study of 815 patients in a university hospital found that 36% had an iatrogenic illness, defined as "any illness that resulted from a diagnostic procedure, from any form of therapy, or from a harmful occurrence that was not a natural consequence of the patient's disease." Of these 815 patients, 9% had an iatrogenic illness that threatened life or produced considerable disability, and for another 2%, iatrogenic illness was believed to contribute to the patient's death.[2,pg.26] Thus this study found that 10-in-500, or 1-in-50, patients were killed by a medical mistake.
A second study looked at 1047 patients admitted to two intensive care units and one surgical unit in a large teaching hospital. Of the 1047 people studied, 480 (46%) had an "adverse event" where an adverse event was defined as "situations in which an inappropriate decision was made when, at the time, an appropriate alternative could have been chosen."[2,pg.26] For 185 patients (18%), the adverse event was serious, producing disability or death.
An important class of medical mistakes is medication errors -- giving a patient the wrong medication, the wrong dose, or inappropriate combinations of medications. TO ERR IS HUMAN estimates that medication errors both inside and outside hospitals killed 7,391 people in the U.S. in 1993,[2,pg.27] but the report acknowledges that, "Current estimates of the incidence of medication errors are undoubtedly low because many errors go undocumented and unreported."[2,pg.29] The problem seems to be getting worse as doctors prescribe more drugs. Between 1983 and 1993, hospital patient deaths due to medication errors increased 2.4-fold while deaths from medication errors among outpatients increased an astonishing 8-fold.[2,pg.28]
TO ERR IS HUMAN reports that doctors often do not consider possible interactions among drugs that they prescribe to a patient. The report says, "Physicians do not routinely screen for potential drug interactions, even when medication history information is readily available." TO ERR IS HUMAN goes on to describe a study of 424 randomly-selected patients in a hospital emergency room. Nearly half of these patients (199, or 47%) received new medications as a result of their hospital visit and in 10% of those -- 19 individuals, or 4.7% of the study group -- received medications that added "potential adverse interactions." "In all cases," TO ERR IS HUMAN reports, "a medication history was recorded on the patients and available to the physicians."[2,pg.33]
Children and old people are particularly prone to medication errors, mainly related to incorrect doses. In one 4-year study of a pediatric intensive care unit, iatrogenic injury due to a medication error occurred among 3.1% of 2147 children -- a rate of one iatrogenic injury among every 33 intensive care admissions.[2,pg.29]
A 1987 study found that physicians prescribed inappropriate medications for nearly 25 percent of all older people.[2,pg.33]
And physicians are not the only part of this problem. A study of pharmacists in Massachusetts found that in a year's time 2.4 million prescriptions (4% of all prescriptions) were improperly filled at the drug store. Eighty-eight percent of these pharmacist errors involved giving patients the wrong drug or the wrong strength.[4]
Lastly, available data about medication errors probably underestimate the true size of the problem. To ERR IS HUMAN says, "Current estimates of the incidence [occurrence] of medication errors are undoubtedly low because many errors go undocumented and unreported."[2,pg.29]
TO ERR IS HUMAN acknowledges that the true death rate from medical mistakes may exceed 1-in-500 for other reasons. The 1-in-500 figure is the in-hospital death rate. "Although many of the available studies have focused on the hospital setting, medical errors present a problem in any setting, not just hospitals."[2,pg.2] And: "...[L]ittle if any research has focused on errors or adverse events occurring outside of hospital settings, for example, in ambulatory care clinics, surgicenters, office practices, home health, or care administered by patients, their family, and friends at home."[2,pg.25] The death rate from medical mistakes in nursing homes has not been reported. However, one study of medications in nursing homes estimated that, for every dollar spent on prescription drugs, $1.33 is spent treating iatrogenic injuries and deaths caused by those drugs.
To ERR IS HUMAN presents a series of recommendations for improving medical safety. The stated goal is to reduce deaths from medical mistakes in hospitals to 1-in-1000 within 5 years. The recommended way to achieve the goal is to make medical errors expensive: "The combined goal of the recommendations is for the external environment to create sufficient pressure to make errors costly to health care organizations and providers, so they are compelled to take action to improve safety," the report says.[2,pg.3]
Thus the National Academy of Medicine acknowledges that laudable motives ("First do no harm"), good intentions, years of specialized training, and voluntary compliance cannot enforce safety protocols. What works is a hefty monetary penalty.
We should all remember this the next time Congress tries to limit the opportunity for citizens to sue corporations and individuals who sell unsafe products or services, dangerous chemicals, and other hazardous technologies. Tort litigation and stiff penalties provide our best hope of limiting harmful behavior.

[1] Emily Yoffe, "Doctors Are Reminded, 'Wash Up!'," NEW YORK TIMES November 9, 1999, pg. F-1.
[2] Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, editors, TO ERR IS HUMAN; BUILDING A SAFER HEALTH SYSTEM (Washington, D.C.: National Academy Press, 1999). ISBN 0-309-06837-1.
[3] Using data from TO ERR IS HUMAN (pgs. 1 and 22), the average probability of death by medical mistake after being admitted to a hospital is: the probability of an "adverse event" caused by medical management (0.033) multiplied by the probability that the adverse event will be fatal (0.112) multiplied by the probability that the adverse event was caused by human error (0.555); so 0.033 * 0.112 * 0.555 = 0.002 = 1/500. The low death estimate for hospital deaths is 33.6E6 * 0.029 * 0.088 * 0.53 = 43,700; the high death estimate is 33.6E6 * 0.037 * 0.136 * 0.58 = 98,000.
[4] We had to make some assumptions to derive the 4% figure. TO ERR IS HUMAN, pg. 33, says 2.4 million prescriptions were improperly filled in Massachusetts in a recent year. We do not know how many total prescriptions are filled in a year in Massachusetts, but we can estimate the number this way: TO ERR IS HUMAN, pg. 27, says 2.5 billion prescriptions were filled in the U.S. in 1998. In 1998, the U.S. population was about 270 million people, so each person had 9.2 prescriptions filled (average) in 1998. In 1997, the Massachusetts population was about 2.32% of the U.S. population, so in 1998 when the U.S. population was 270 million, the Massachusetts population was probably about 6.3 million people; if each person had 9.2 prescriptions filled in 1998 then the total filled in Massachusetts was about 58 million. Therefore 2.4

MySpace or SpySpace?

2006-06-08T10:37:00.000-07:00

This week's top stories from the web's No.1 science and technology news service

8 June 2006

Welcome to the New Scientist newsletter, which this week reveals that personal information posted on social networking websites such as MySpace could be used by security agencies, that miners' health could pay the price for a nuclear future, and describes how plants predict volcanic eruptions...

EDITOR'S CHOICE

Paul Marks, Chief Technology Correspondent

Big Brother is watching you

If you are one of the millions of people using social networking websites such as MySpace and Friendster, be careful what you reveal about yourself. The US National Security Agency is looking at ways to harvest the information that people post about themselves on such networks. It could use advances in internet technology to combine the data with personal details such as banking, retail and property records, allowing it to build profiles of individuals. The idea is to identify terrorists and other criminals, but privacy groups worry that this hi-tech snooping could lead to miscarriages of justice...MORE

New Scientist Podcast available every Friday!
Be the first to download the New Scientist podcast and hear our top stories and interviews. Click here.

THIS WEEK'S PRINT EDITION

FEATURES
Is space-time actually a superfluid?
It's a radical suggestion, but it would certainly solve one of cosmology's greatest mysteries - the problem of establishing a universal time

Raiders of the lost storms
Will a warmer world bring more monster hurricanes? Hunting for traces of ancient tempests should reveal the answer

Genetic tools you can trust
Genetic engineering has always been a bit of a botched job. At last we have the machinery to get it right - and you'll be amazed at the difference

Architects bridge the void
Gravity-defying arches and domes to rival medieval masterpieces are getting their inspiration from a surprising source

NEWS
Heat is on for desert life
Lab in a bath of oil
Does dark matter suck?

SPECIAL SUBSCRIPTION OFFER

You are currently subscribed to this newsletter at the email address pltaylor.honestmed@blogger.com. You can change your address or email preferences here or unsubscribe from all New Scientist mailings.

© Copyright Reed Business Information Ltd. 2006

Post your comments

2006-06-07T16:40:00.000-07:00

Please feel free to post your comments to this blog by email to:
pltaylor.honestmed@blogger.com We appreciate your interest and participation in promoting honesty and ethics in health care!

Comments??

2006-06-03T10:12:00.000-07:00

Haloscan commenting and trackback have been added to this blog.

High Risk Painkillers

2006-06-02T16:26:00.000-07:00

High Dose Common Painkillers Raise Heart Risks

02 Jun 2006

Common painkillers, known as NSAIDs, may raise the risk of having a heart attack or vascular event, say researchers who studied drug trials totalling 140,000 participants. It seems high doses of Ibuprofen may present patients with the same risks as such drugs as Vioxx (cox-2 inhibitors).

You can read about this study in the British Medical Journal.

The researchers collected data from 138 trials. They found that selective cox-2 inhibitors can raise the risk of heart attack and stroke by up to 42%. Examples of cox-2 inhibitors are Celebrex (still on sale), Bextra (no longer on sale) and Vioxx (no longer on sale).

The researchers also found that other NSAIDs, such as Ibuprofen can also raise the risk of vascular events. 800 milligrams of ibuprofen three times a day over the long term, when compared to a placebo, was linked to a 51% raised risk of heart attack or stroke. Diclofenac, 75 milligrams twice daily raised the risk by 63%. Aleve (Naproxen) did not seem to be linked to any raised risk.

What Are NSAIDs (Non-steroidal anti-inflammatory drugs)?

NSAIDs are pain killers. They include such drugs as ibuprofen and are commonly used by arthritis patients. Cox-2 inhibitors are also types of NSAIDs - they are newer drugs. Cox-2 inhibitors, unlike other painkillers, are safer for the patient's stomach.

How much is the raised risk?

Ibuprofen and diclofenac, in larger doses over the long-term, add an extra three cases of heart attack or stroke per thousand patients per year (approximately)

What about OTC Ibuprofen?

Ibuprofen bought over the counter (OTC) does not have a high dose. The raised risk of heart attack or stroke is for high doses over the long term.

This study did not find a link for high dose over the short-term, or low dose over the long-term. It only found a link for patients on a high dose over the long-term. Ibuprofen, at 800 milligram three times a day, is three times the recommended daily dose - the study found a risk only at this dosage over the long-term.

You can only get Ibuprofen at that high dose with a doctor's prescription. It is used for treating chronic pain.

Written by: Christian Nordqvist
Editor: Medical News Today

Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=44462

Seniors - People Shun Help for Illnesses They View as 'Untreatable'

2006-06-01T14:02:00.000-07:00

	Seniors May 29, 2006
	Home \| Diseases \| Symptoms \| Procedures \| Drug Library

Thanks for joining Us.
DrKoop Staff

This Week's News

People Shun Help for Illnesses They View as 'Untreatable'
Study finds they're less likely to get tested for cancer, AIDS

Study Compares Brain Aneurysm Treatments
Both 'coiling' and 'clipping' work well over long term

One-Third of U.S. Adults Diabetic or Pre-Diabetic
And nearly 30% of diabetics remain undiagnosed, study finds

Daily Drinking Cuts Heart Disease Risk for Men
Benefit of moderate drinking doesn't extend to women, study suggests

Biomarkers Could Drive Arthritis Research
Newly discovered markers give insights to spondylarthritis, experts say.

More News | Health Tools | Newsletters | Health Encyclopedia

Please do not reply to this e-mail. Mail sent to this address cannot be answered

You are receiving this newsletter because you subscribed to it.

Unsubscribe from this Newsletter | Sign up for more of DrKoop's Health Newsletters

DrKoop respects your privacy. See our Privacy Policy.

Copyright © 2005 ChoiceMedia Inc. All Rights Reserved.

Yahoo! News Story - US Medicare reveals hospital procedure prices - Yahoo! News

2006-06-01T13:07:00.000-07:00

(admin@honestmed.com) has sent you a news article.
(Email address has not been verified.)
------------------------------------------------------------
Personal message:

US Medicare reveals hospital procedure prices - Yahoo! News

http://news.yahoo.com/s/nm/20060601/hl_nm/medicare_pay_dc

============================================================
Yahoo! News
http://news.yahoo.com/

Efforts to Prevent Hospital-Acquired Infections

2006-06-01T12:53:00.000-07:00

Washington Times Examines Efforts To Prevent Hospital-Acquired Infections

01 Jun 2006

The Washington Times on Monday examined increased efforts by medical centers to prevent hospital-acquired infections. An estimated one in 20 patients contract infections during hospital stays, and about 90,000 die annually as a result of such infections, according to the Times. CDC recently awarded $10 million to five medical centers to research new approaches to prevent hospital-acquired infections, which often are difficult to treat because of resistance to antibiotics. For example, Washington Hospital Center displays posters with pictures of staff members to remind employees about hand washing, the most effective approach to prevent hospital-acquired infections. "You cannot go 10 feet without exposure to alcohol containers (on the wall) enabling the hospital worker to wash his hands," Nancy Donegan, director of infection control at WHC, said. She added, "We provide all kinds of packaged education to try to keep the issue relevant. It's sort of what people learned from their mothers when they were three years old." In addition, Shmeul Shoham, an attending physician in infectious diseases at WHC, has invented gelFast, an antiseptic alcohol gel dispenser worn at the waist that allows WTC employees to sanitize their hands between visits to patients (Geracimos, Washington Times, 5/30).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=44354

Abuse of prescription drugs fuelled by online recipes

2006-06-01T10:14:00.000-07:00

This week's top stories from the web's No.1 science and technology news service

1 June 2006

Welcome to the New Scientist newsletter, which this week reveals how the internet is fuelling the dangerous misuse of prescription drugs, that letting newborns cry could end in tears, and the electric power of chocolate...

EDITOR'S CHOICE

Linda Geddes, Biomedical News Editor

Not What the Doctor Ordered

It's a worrying trend. A growing number of people are tampering with prescription drugs to get high - and the internet is making it easier for them. Some websites are providing would-be drug abusers with home-grown recipes for misuse - such as injecting or chewing drugs extracted from skin patches. The problem is that a single patch can contain a potentially lethal dose of painkiller. Toxicologists are calling for improvements in anti-tamper technologies...MORE

New Scientist Podcast available every Friday!
Be the first to download the New Scientist podcast and hear our top stories and interviews. Click here.

THIS WEEK'S PRINT EDITION

FEATURES
How to live to 100... and enjoy it
New Scientist reveals how you can maximise your tally at the final checkout, without compromising your urge to dance in the aisles along the way

Wanted: The ultimate online-music search
Right now, there are over 25 million digital music tracks available - twice as many as you could ever listen to. This calls for a whole new type of search engine

Have we got gravity all wrong?
Virtual replays of two of the most puzzling space missions ever undertaken - the Pioneer 10 and 11 probes - could solve the mystery

NEWS
Jung for sale
The ocean floor - can they dig it?
Focus on Ritalin

SPECIAL SUBSCRIPTION OFFER

How to read a Rx

2006-05-31T00:23:00.000-07:00

Your doctor prescribed a new medication, but you forget what it's called. You're supposed to take two tablets once a day. Or is it one tablet twice a day? Unable to read your doctor's handwriting, you can make out what looks like "tab bid am and hs" on the prescription form. Confused, you head for the drugstore, confident your pharmacist will be able to clear things up.

Pharmacy workers are human, and humans can make mistakes. That's why, before you leave your doctor's office, you need to know several things: The name of the medication, what dosage you're supposed to take and - because we all tend to forget sometimes - how to read the prescription form.

You want to be sure that the medication you pick up at the drugstore is the same one your doctor ordered. You also want to know that if your doctor scribbled "one tablet twice a day" on your prescription form, the pharmacy didn't mistakenly type "two tablets once a day" on your label.

Cracking the code

Below is a list of abbreviations used by doctors to write prescriptions. You can memorize them or simply keep them in your wallet. Take time to decipher your next prescription before dropping it off at the drugstore. That way you'll know you're getting what was Rx'ed.

Rx, by the way, is Latin for "recipe."

a.c.	before meals	b.i.d.	Twice as day
t.i.d	Three time a day	q.i.d	Four times a day
Tab	Tablet	T	One tablet
TT	Two tablets	Cap	Capsule
D	Day(s)	Gt	Drops
h.s.	Bedtime	I.M.	Into the muscles
I.V.	Into the vein	Mg	Milligram(s)
mL	Milliliters	Mg/mL	Milligram(s)/milliliter
O.D	Right eye	O.S.	Left eye
O.U.	Each eye	p.c.	After meal
p.o	By mouth	p.r.n.	as needed
qh	Every hour	q3h	Every 3 hours
qam	Every morning	qhs	Every night/bed time
qd	Everyday	q.o.d.	Every other day
s.l.	Under the tongue	Tsp	Teaspoon
Tbsp	tablespoon

You now know that the above example ("tab bid am and hs") directs you to take one tablet twice a day - in the morning and at bedtime.

Questions to ask your doctor or pharmacist

Just because you can read the prescription label or even decipher the code on the prescription form doesn't mean you shouldn't ask questions. Always ask your doctor or pharmacist the following things before starting a new medication:

What are common side effects of this medicine?
What should I do if I miss a dose?
Are there foods, other drugs or activities that I should avoid while taking it?
When should I take this medicine? Should I take it before, after or with meals?

Educating yourself is the best way to take charge of your own health. By knowing beforehand how to take medication as prescribed, you reduce your risk of becoming a victim of medical error.

For more information please ask your physician on your next visit.

Colon Screening Not Followed Up

2006-05-30T22:28:00.000-07:00

Many Patients Not Receiving Follow-up Tests After Positive Screening For Colon Cancer

30 May 2006

A UCLA/Veteran's Affairs study showed that more than 40 percent of patients who initially had received a positive result on a fecal occult blood test (FOBT) -- an initial screening tool for colon cancer -- did not receive appropriate diagnostic follow-up tests such as a colonoscopy or barium enema in 2002. According to the authors, the study may even underestimate this problem in the United States, since previous studies have shown the VA's level of preventive care and follow-up traditionally has been higher than at most other health care settings.

Published in May in the journal Diseases of the Colon & Rectum, the UCLA/VA study is one of the largest reviews of colorectal screening and follow-up patient data to date. The study used data from the VA, the nation's largest integrated health care system. The study was performed as a prelude to a national VA effort, now underway, to improve colorectal cancer screening and suggested the need for better medical follow-through for patients with potential colon cancer.

Study authors took advantage of the VA's ongoing quality improvement program to analyze 39,870 patient records. Overall, 61 percent of eligible VA patients had been screened for colorectal cancer, a rate significantly higher than the national average. Of the screened population, 313 patients had an abnormal FOBT result. Only 59 percent, or 185 patients, of this group received follow-up diagnostic tests such as a colonoscopy or a barium enema. Forty-one percent, or 128 patients, received no follow-up at all in the six months following the FOBT.

"As a nation, we are getting better in providing colorectal cancer screening, but we need to do a much better job in following-up with diagnostic tests for those patients who have abnormal screening results," said Dr. David A. Etzioni, principal investigator and a Robert Wood Johnson Clinical Scholar in the Division of General Surgery at the David Geffen School of Medicine at UCLA.

The authors believe that the study has implications for how health care systems monitor their own quality. "Any healthcare system that provides cancer screening programs needs to track each step in the screening process," Etzioni said. "Many patients were not offered any kind of total colon examination after having a positive screening for colon cancer. Traditionally, quality-of-care assessments just look at initial screening rates for colon cancer, but this study reveals that efforts should focus on the entire diagnostic process to help ensure that patients don't slip through cracks in the system."

In the study, researchers identified several possible factors why patients didn't receive follow-up tests. Fifteen percent of the patients who did not receive follow-up did not have a primary care visit in the six months after the positive FOBT screening. The remaining patients in this group saw a primary care physician but were not referred for a follow-up colonoscopy. For those who did receive follow-up tests, there was a long period between having a positive FOBT to receiving a colonoscopy (250 days) or barium enema (120 days).

"These findings have helped the VA identify key issues to spur more timely follow-up testing, and other systems around the country might do the same" Etzioni said.

Potential solutions include educating patients to advocate for screening and follow-up, and putting electronic systems in place to track follow-up.

The study was funded by the Robert Wood Johnson Foundation Clinical Scholars Program; the Department of Veterans Affairs, Health Services Research and Development; and the National Cancer Institute Colorectal Cancer Quality Enhancement Research Initiative, Service Directed Project.

Other study authors include: Elizabeth M. Yano, Dr. Lisa V. Rubenstein, Martin L. Lee, Dr. Clifford Y. Ko, Robert H. Brook, Patricia H. Parkerton and Dr. Steven M. Asch, all from UCLA.

Rachel Champeau
rchampeau@mednet.ucla.edu
University of California - Los Angeles
http://www.newsroom.ucla.edu

Canadians Healthier?

2006-05-30T14:33:00.000-07:00

Study: Canadians healthier than Americans

By MIKE STOBBE, Associated Press Writer 13 minutes ago

You can add Canadians to the list of foreigners who are healthier than Americans. Americans are 42 percent more likely than Canadians to have diabetes, 32 percent more likely to have high blood pressure, and 12 percent more likely to have arthritis, Harvard Medical School researchers found. That is according to a survey in which American and Canadian adults were asked over the telephone about their health.

The study comes less than a month after other researchers reported that middle-aged, white Americans are much sicker than their counterparts in England.

"We're really falling behind other nations," said Dr. Steffie Woolhandler, a co-author of the Canadian study.

Canada's national health insurance program is at least part of the reason for the differences found in the study, Woolhandler said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.

James Smith, a RAND Corp. researcher who co-authored the American-English study, disagreed. His research found that England's national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.

"To me, that's unlikely," he said of the idea that universal coverage explains international differences.

Woolhandler said her findings were different in at least one important respect: In the Canadian study, insured Americans and Canadians had about the same rates of disease. It was the uninsured Americans who made the overall U.S. figures worse, she said.

The study, released Tuesday, is being published in the American Journal of Public Health. It is based on a telephone survey of about 3,500 Canadians and 5,200 U.S. residents in 2002-03. Those surveyed were 18 or older.

The results are based on what those surveyed said about their health. In contrast, the researchers in the American-English study surveyed participants and also examined people and conducted laboratory tests on them.

The new study found that 6.7 percent of Americans and 4.7 percent of Canadians reported having diabetes; 18.3 percent and 13.9 percent, respectively, reported having high blood pressure; and 17.9 percent and 16.0 percent said they had arthritis. The Americans also reported more heart disease and major depression, but those difference were too small to be statistically significant.

About 21 percent of Americans said they were obese, compared with 15 percent of Canadians. And about 13.5 percent of the Americans admitted to a sedentary lifestyle, versus 6.5 percent of Canadians. However, more Canadians were smokers 19 percent, compared with about 17 percent of Americans.

About 42 percent of the Americans rated their quality of health care as excellent, while 39 percent of Canadians did.

Also, 92 percent of American women said they had a Pap test within the last five years, while 83 percent of Canadian women had. But Canadians have lower death rates from cervical cancer. "It's a little hard to interpret," Woolhandler said.

One more plus for the Americans: Fewer than 1 percent said they were unable to get needed care because of long waits, compared with 3.5 percent of Canadians.

However, about 80 percent of Americans had a regular doctor, while 85 percent of Canadians did. And nearly twice as many Americans said there were medicines they needed but couldn't afford (9.9 percent versus 5.1 percent).

New Yorkers Demand Fair Share Health Care

2006-05-30T10:54:00.000-07:00

New Yorkers Demand Fair Share Health Care
Posted By Mike Hall On 25th May 2006 @ 16:29 In Legislation & Politics, In the States

“No employee of a multi-billion dollar corporation should be forced to go without medical care.”

That’s what the t-shirts said on more than 400 New Yorkers who told lawmakers at a special State Assembly hearing May 23 in Albany to pass Fair Share Health Care legislation.

Fair Share legislation and initiatives, which the AFL-CIO, unions and health care advocates are pushing in more than 30 states, would ensure that the largest corporations like Wal-Mart stop shifting health care insurance costs to workers, taxpayers and other businesses. In general, the initiatives require large, profitable companies to spend a percentage of their payroll ...

Article taken from AFL-CIO Weblog - http://blog.aflcio.org
URL to article: http://blog.aflcio.org/2006/05/25/new-yorkers-demand-fair-share-health-care/

Squandered!!

2006-05-19T14:19:00.000-07:00


Millions Squandered in Unnecessary Tests Ordered in Routine Doctor Visits
Georgetown University Medical Center 5/19/2006 3:34:16 PM
May 19, 2006 Washington, DC Unnecessary medical tests are costing the U.S. health care system millionsand potentially billions of dollars per year, and add unnecessary patient stress, say researchers from Georgetown University Medical Center and Johns Hopkins University in the June issue of the American Journal of Preventive Medicine. Not only are the tests unwarranted, but false-positive results lead to further tests and compound the expense, says the studys lead author, Dan Merenstein, MD, an assistant professor in the Department of Family Medicine at Georgetown. Many physicians, as well as their patients, appear to believe that a routine health exam should include a number of tests they feel can screen for unknown diseases, but the evidence shows that some of these tests are less than beneficial when used in this way, he said. More is not always better, and understanding this is especially important now that Medicare has begun to reimburse complete physicals. The study looked at recommendations of the United States Preventive Services Task Force (USPSTF), a panel of experts that grades preventive screening measures based on evidence of their effectiveness. The researchers focused on C and D tests to see how often they were being used in routine patient visits. In asymptomatic patients, a C test are those tests the panel made no recommendation for use. D tests, are those which the panel recommended against as risks outweigh the benefits. These C and D procedures fell into two categories: interventionsthis includes an electrocardiogram (EKG) that records heart activity and X-rays ? and procedures that are analyzed in a laboratory: a urinalysis; a hematocrit which measures volume of red blood cells in blood; and a complete blood count, or CBC, which measures red and white blood cells and platelets, in blood. To conduct the study, the researchers reviewed data from the National Ambulatory Medical Care Survey (NAMCS) sponsored by the Centers for Disease Control. They analyzed 4,617 general examination visits by adults over age 20. The researchers then looked at how many of the D category tests urinalysis, EKG, and X-rays were ordered, and found at least one of the three D interventions was ordered 43-46% of the time. The researchers then extrapolated their findings into a national picture of use, and estimated that annual direct medical costs for the three D category tests those whose use the panel recommended against -- ranged from $47 million to $194 million. Adding the other two tests, those in the C category urinalysis and blood testsadded an additional $12-$63 million. What the numbers miss, however, according to researchers, are the various costs that occur when a test is false positive ? that is, wrongly shows evidence of a health problem. For example, studies show that 20-30 percent of EKG tests result in false positive results, and patients with these results usually have follow-up exams that are much more expensive, Merenstein says. We estimate that if 20 percent of EKGs are false, the follow-up tests will cost about $683 million, and that doesnt account for the stress that a patient feels, the time off from work they have to take, and the possible complications that result from the follow-up test. Among their other findings is that men are given more of these tests than are women, and that Hispanics are also offered more tests than non-Hispanic patients. Merenstein and his two co-authors say among the many reasons that diagnostic interventions which lack evidence of benefit in asymptomatic patients are used are: * Studies have shown that many patients have expectations of receiving particular tests when visiting physicians. * It is possible that physicians are ordering these tests defensively, to guard against potential lawsuits. * Physicians may not be aware of USPSTF recommendations. * There may be a financial incentive to ordering these tests, especially if a physicians office includes a laboratory. But the fact is that less use of unwarranted interventions will likely eliminate waste and improve overall quality of healthcare in the United States, Merenstein said. The study was funded by the Robert Wood Johnson Clinical Scholars Program. Merensteins co-authors include Neil Powe, M.D., and Gail Daumit, M.D., of Johns Hopkins University. About Georgetown University Medical Center Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalisor care of the whole person. The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, and the world renowned Lombardi Comprehensive Cancer Center. For more information, go to http://gumc.georgetown.edu.

Vioxx Dangers

2006-05-19T13:56:00.000-07:00

Vioxx Starts Adversely Affecting Patients After 4 Months, Not 18 Months

19 May 2006

Merck had initially claimed that Vioxx begins to have adverse effects on the cardiovascular system after 18 months' use, but data the company submitted to the FDA last week shows this starts to happen after just 4 months, according to the Wall Street Journal.

Dr. Eric Topol, who authored 16 articles on Vioxx and was behind the move to investigate the drug, says there has never been any data to back the theory that adverse effects started after 18 months' use.

A study carried out at McGill University, Montreal, Canada, and published in the Canadian Medical Journal, revealed that one quarter of Vioxx users who had a heart attack, had one within two weeks of starting treatment.

Many experts say there are effective alternative drug combinations which do not have the health risks of cox-2 inhibitors. They believe that Celebrex, the only cox-2 inhibitor on the market, may also hold risks for the patient.

According to the Wall Street Journal, new data shows that Vioxx was more dangerous than a placebo within four months of starting treatment - not significantly more dangerous, but enough to indicate that the danger started at 4 months, not 18 months of use.

Merck has always maintained that the risk of heart attack only happens after long-term use.

Merck is facing thousands of lawsuits from patients who took Vioxx and claim it caused them either to have a stroke or a cardiovascular event. With payouts of over $30 million per case it loses, the company could end up having to pay out billions of dollars in compensation.

Written by: Christian Nordqvist
Editor: Medical News Today

Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=43705

New Antibiotic

2006-05-18T09:17:00.000-07:00

Super Antibiotic For Hospital Superbug MRSA

18 May 2006

Merck scientists have discovered an antibiotic that is effective in destroying MRSA, otherwise known as the hospital superbug. This antibiotic, unlike others, blocks the enzymes that produce fatty acids - essential for the construction of the membranes of bacteria. The compound binds to FabF.

If the drug successfully passes clinical trials, it will be only the third new antibiotic type in the last four decades. Most modern antibiotics still work on variations of compounds discovered in the late 1940s to 1950s. Current antibiotics either inhibit a bacterium's ability to build a membrane or prevent it from creating proteins or DNA.

This fact, that most antibiotics are basically quite similar, may be one of the main reasons for the increasing incidence of antibiotic resistance. Antibiotic resistance is also the result of overuse of antibiotics.

Any completely new type of antibiotic is viewed with enthusiasm by doctors because it may smash resistance on the head and give us a headstart of many decades.

The researchers were looking through more than one quarter of a million natural products when they came across platensimycin' found in a soil sample from South Africa. Platensimycin is produced by Streptomyces platensis, a type of fungus. Platensimycin was found to be a powerful inhibitor of many Gram-positive bacteria, including many Staphylococcus strains.

Initially, researchers found that platensimycin eliminated S. aureus bacteria, related to MRSA, from infected mice. According to their preliminary investigations, there were no toxic side-effects. After further tests, they found platensimycin to be very effective against MRSA and many other types of bacteria.

This could be welcome news for doctors who are concerned at the rising numbers MRSA infection cases in hospitals throughout most of the world. The majority of pharmaceutical companies have moved away from antibiotic research. Over the last ten years the number of new antibiotics coming onto the market has gone down, while the number of MRSA cases has been steadily rising. MRSA is resistant to most antibiotics.

The scientists said that this potential breakthrough is in its birth and we could be looking at several years before a new, effective and safe product is on the market.

Written by: Christian Nordqvist
Editor: Medical News Today

Article URL: http://www.medicalnewstoday.com/healthnews.php?newsid=43612